SBANCA 2019 Membership Form
Spina Bifida Association of the National Capital Area
First & Last Name
City, State, Zip
Please provide contact information for our membership directory, especially an up-to-date email address. (We request birth years of children and siblings to help us buy appropriate gifts for the annual Christmas party.)
Person with Spina Bifida
Year of birth
Birth years of siblings (if children)
This fee includes full membership with voting rights in SBANCA and offers the following benefits free of charge: monthly support group meetings; an annual holiday party, picnic, and bowling party; membership directory, loan closet; and peer support.
Payment options (select one)
We are paying the $25 membership fee via PayPal. (Instructions will appear in the next screen.)
We will pay $25 by check, payable to SBANCA. Mail to P.O. Box 523415, Springfield, VA 22152. (Write "2019 Membership" on the memo line.)
We would like to receive full membership benefits and request a fee waiver.
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