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Become a member of Cure SMA Foundation of India

Please fill up the following form for a one time life time registration & membership with Cure SMA Foundation of India. Membership entitles you to receive our newsletters, latest updates on events and work in other areas. You also can become connected to other families and individuals affected by SMA globally. To become a member, please fill out this online form for submission electronically – or print it out the downloadable membership form and mail or courier it to us at the head office. Send an email to info@curesmaindia.org/curesmaindia@gmail.com OR courier to our address given under contact. You will be given a unique membership ID. We ask for a one time registration fees of INR500/- and monthly membership fees of INR1000/- per family to help cover printing, mailing, organizing events and administrative costs. The membership fees may be paid quarterly as well @3000/- per quarter. Instructions for making a donation will show after you click ‘Submit.’ We ask one member of the family to fill up the membership form and get a membership ID.

Username

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Password

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Strength: Very Weak

Number of SMA Warrior/s in your family

Husband, Wife, Children up to 4

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SMA Warrior/s Name/s

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Your relationship with SMA Warrior

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Please give a brief description about your family w.r.t SMA Warrior/s :

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Name

Gender

DOB

SMA Type

SMA Warrior

Relationship with warrior

Name 1

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Select Option

Male

Female

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DOB 1

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Type 1

Type 2

Type 3

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Select Option

Yes

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Relationship 1

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Name 2

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Male

Female

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DOB 2

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Type 1

Type 2

Type 3

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Yes

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Relationship 2

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Name 3

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Select Option

Male

Female

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DOB 3

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Type 1

Type 2

Type 3

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Select Option

Yes

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Relationship 3

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Now, please complete the form below:

First Name

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Last Name

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Email Address

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Address

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Apt

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City

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State

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Postal Code

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Home Phone

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Work Phone

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Cell Phone

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Please upload pictures (Family picture & other pictures of SMA Warrior/s) and diagnosis reports :

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Submit

No matter what question, our team is here to help.

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