Families of Spinal Muscular Atrophy

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If you or a family member are newly diagnosed with SMA please email infopack@fsma.org or call (800) 886-1762 and we will provide you with an informational packet and details of other support we can help with.

Join FSMA

To make your repeat visits to our site more personalized and convenient, please take just a few moments to register below.

Membership Options

Membership:

I am/have/had a family member or friend affected with SMA and would like to become a member.

I do not know anyone affected but would like to become a member.

I am a professional researcher or clinician and would like to become a member.

I do not wish to become a member at this time.
Please complete the information below to register for our web site only.

Contact Information

Contact

First Name:

Last Name:

Please be sure to complete spouse's name, if applicable.

Spouse First Name:

Spouse Last Name:

Email Address:

Confirm Email Address:

Organization/Company/Institution:

Address

Address Type:

Home Work

Address Line 1:

Address Line 2:

City:

State:

Country:

Zip Code:

Phone Numbers

Home Phone:

Work Phone:

Mobile Phone:

Contact List:

I authorize FSMA to release my name, phone or email to other SMA families.

Please provide a login and password to use when logging into the Web Site. Logging in gains you access to special features and allows us to better serve your areas of interest.

Password:

Confirm Password:

Note: Passwords must be at least 4 characters in length.

Please provide a hint question and answer to use if you forget your password and cannot access the Web Site.

Hint Question:

Hint Answer:

* indicates a required field

Other Information

Areas of Interest
	Areas of Interest:	Are you interested in holding a FSMA fundraiser?

Affected Person
*	Relationship to Affected Person:
*	First Name:
*	Last Name:
*	Sex:
	Date of Birth:
	SMA Type:
	Date of Diagnosis:
	If Applicable, Date of Death:
	Other Family Members:
	Areas of Interest:	Are you interested in holding a FSMA fundraiser?

Researcher/Clinician Information
	Areas of Interest:	Basic Research Drug Discovery and Development Clinical Trials

FSMA Membership

We ask for a donation for membership to help cover the costs associated with the printing and mailing of our newsletters. You should receive quarterly editions of both the Directions newsletter and Research Compass. We hope these publications provide valuable information and useful support to all our members.

Donation:

Family $30

Professional $35

International $40

I cannot provide a donation at this time

	Donation Amount:
*	Credit Card Number:
*	Credit Card Security Code:
*	Credit Card Type:
*	Expiration Date:

An email confirmation of your registration and membership will be sent to you shortly.

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