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CONNECTICUTFERTILITYASSOCIATES SPERMDONATION×EMBRYOTRANSFER CONSENTBYGENETICFATHER (GestationalCarrierArrangement) IntendedParentName: SS#: IntendedParentName: SS#: I, the undersigned, request, authorizeandconsentforgestationalsurrogacyatConnecticutFertility

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Connecticut Fertility Associates sperm refers to the sperm samples provided by donors at Connecticut Fertility Associates for use in fertility treatments.

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Information such as the donor's personal details, medical history, genetic information, and consent to donate sperm must be reported on Connecticut Fertility Associates sperm.

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