Families of
Spinal Muscular Atrophy
Canada
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Families of Spinal Muscular Atrophy Canada
P.O. Box 97
Rivers, Manitoba R0K 1X0 
(800) 866-0016
http://www.CureSMA.ca

 
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When you join FSMA Canada, you will receive all the benefits of joining FSMA-US, including the newsletters Directions and Compass. You will also receive our newsletter, Northern Directions, and be added to the our e-list for SMA research news. You will be giving and receiving support to other families in Canada and around the world, and helping to find a cure for SMA. For more information, see membership information on the FSMA-US site.

To join Families of SMA Canada, fill out the form below and click the "Send membership information" button. You'll receive e-mail confirmation and be asked to mail us your donation or donate online. You may also use our printable Membership Form.
Title:
First name: MI:
Last name:
E-mail address:
Street address:
City:
Province:
Postal code:
Country:
Home phone:
Business phone:
I am/have/had a family member or friend affected with —
SMA Type:
Name:
Father's name:
Mother's name:
Birth date (mm/dd/yyyy): Male Female
Relationship to you:
Diagnosis date (mm/dd/yyyy):
Current status:
Date of Death (if applicable):
Additional info:
Membership Category 
We ask for a yearly donation for membership to help cover costs for printing and mailing of newsletters. Your membership is a tax-receiptable donation. We try to make all our materials available based on need, never ability to pay. If you cannot afford a membership donation at this time but would still like to be a member, please check off 'Membership Scholarship.' Scholarships are available only to Canadian residents.
Family/Affected/Friend - Cdn $30 New Renewal
Professional - Cdn $35 New Renewal

International (outside Canada) - please join FSMA-US
Membership Scholarship needed New Renewal

I wish to support Families of SMA Canada by making an additional donation:

Pledge amount: Cdn $

I have already received my initial information packet
I would like to receive some back copies of the FSMA newsletter, Direction. (Please indicate how many back issues you want - up to 5 - or if there is a certain issue you want to get copies of: Please include $1 per back issue.)
I authorize Families of SMA Canada to release my name, address, phone number and email address to other SMA families.

 

(Please report any problems using this form to bettylou@curesma.ca .)
 
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