FamilieSCN2A Birthday Club
Signing up to the Birthday Club will give the FamilieSCN2A Foundation permission to use pictures on Instagram, Twitter, Facebook & SCN2A Yearly Calendar.
Email address *
SCN2A Patient First & Last Name *
Birthday Date *
MM
/
DD
/
YYYY
Would you like a birthday card mailed? *
If yes, Please provide your mailing address
Parent/Guardian First & Last Name *
Please submit a picture
Please select the Social Media Platforms that we can announce your birthday. (Note: Only first names will be used) *
Required
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