You don’t have to navigate your neuromuscular disease journey alone. As a member of the MDA Community, one of the many ways you can connect with others and share your personal story is by participating in the MDA Peer Connections program. We invite you to take advantage of the sharing that is possible through talking with others in similar situations. MDA membership is required to participate in MDA Peer Connections.

Please take the time to answer the following questions so that MDA can learn a little bit more about you. The individual completing this form must be age 18 or over.

You have selected no. A parent or guardian over the age of 18 must complete this form.

If you select No or Not Sure, please click “Get Started” at https://www.mda.org/join-mda.



Person with neuromuscular disease (NMD):








Best Contact Person (if someone other than person with NMD)
For minors, this must be a parent or guardian.






Please select all that apply. (Please know that we will narrow our search based on the specifications provided but cannot guarantee a good fit based on selected specifications. We will do out best to find someone within your geographical vicinity whenever possible.)



Certificate & Release Section
By signing/typing my name in the box below, I hereby authorize MDA to release my name, address, telephone number, e-mail, birth date, parent’s/spouse’s name, and diagnosis to other individuals who have joined the MDA Peer Connections. I further release MDA, its officers, employees, agents, chapters, assignees, licenses, and cooperating entities, their representatives, heirs, administrators, successors and/or assigns from any claims which may arise from my taking part in the MDA Peer Connections. I further understand that I may withdraw my name from future distributions upon written notice to the MDA. 

I affirm that I am the parent/legal guardian of the above-named individual and that I have full authority to authorize his/her participation in the above-mentioned MDA Peer Connections


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