SBANCA 2017 Membership Form
Spina Bifida Association of the National Capital Area
Name
Your answer
Street Address
Your answer
City, State, Zip
Your answer
Directory information
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.)
Email address
Your answer
Home phone
Your answer
Cell phone
Your answer
Person with Spina Bifida
Your answer
Year of birth
Your answer
Birth years of siblings (if children)
Your answer
Membership Fee
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)
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