Become a member of Cure SMA Foundation of IndiaPlease 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 * * Password * Strength: Very WeakNumber of SMA Warrior/s in your family Husband, Wife, Children up to 4SMA Warrior/s Name/s Your relationship with SMA Warrior Please give a brief description about your family w.r.t SMA Warrior/s : NameGenderDOBSMA TypeSMA WarriorRelationship with warrior Name 1Select OptionSelect OptionMaleFemale DOB 1Select OptionSelect OptionType 1Type 2Type 3 Select OptionSelect OptionYesNo Relationship 1 Name 2Select OptionSelect OptionMaleFemale DOB 2Select OptionSelect OptionType 1Type 2Type 3 Select OptionSelect OptionYesNo Relationship 2 Name 3Select OptionSelect OptionMaleFemale DOB 3Select OptionSelect OptionType 1Type 2Type 3 Select OptionSelect OptionYesNo Relationship 3Now, please complete the form below: * First Name * * Last Name * * Email Address * Address Apt * City * * State * Postal Code Home Phone Work Phone Cell Phone Please upload pictures (Family picture & other pictures of SMA Warrior/s) and diagnosis reports : Done(Use Cropper to set image and use mouse scroller for zoom image.)Done(Use Cropper to set image and use mouse scroller for zoom image.)Drop file here or click to select.Submit
