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Membership Form

Home/Membership/Membership Form
Membership Formadmin2022-08-06T14:06:25-04:00

Membership Form

  • Contact Information:

    All personal information will be kept confidential for use within the organization and not shared with outside organizations or entities without consent. All privacy concerns will be respected.
  • As an affiliate of United Spinal Association we try to work together to enhance the lives of people with SCI/D. One of the ways in which we do this is by sharing information with United Spinal that will help better assess and understand the needs of the spinal cord injury community as a whole. This helps provide concrete data that is necessary to move forward with research, develop beneficial programs, and positively influence those who provide important services.
  • Personal Information

  • Date Format: MM slash DD slash YYYY
  • Group information

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