MDA Engage Event Registration Form

Please complete this registration form if you are a person living with neuromuscular disease, a caregiver, family member, friend, or advocate. 

If you are a member of a pharmaceutical or biotechnology company, please do not complete this form. Attendance is available via sponsorship of the event. Please contact your MDA Account Director or email mdapartners@mdausa.org to proceed. 



Registration Information

















Additional Registrations
You can register an additional 5 people by clicking the Add another response button at the bottom of this section. 









I understand and accept that my personal data will be collected as a result of my registration and participation in connection with the MDA Engage events and will be used for future MDA communications. – Single check box with “I accept” Waiver, Release, and Consent. 

In consideration of MUSCULAR DYSTROPHY ASSOCIATION, INC. permitting (me/my child who is under 18) to participate in the above-named event, I hereby, and for (my)(my child's) heirs, executors, administrators, assigns, and all legal guardians, WAIVE AND RELEASE ANY AND ALL RIGHTS AND CLAIMS OF ANY NATURE, FOUNDED IN WHOLE OR IN PART UPON ANY TYPE OF NEGLIGENCE, that (I)(my child) may have against MDA, its directors, officers, employees, agents, chapters, assignees, licensees, volunteers and cooperating entities, their representatives, heirs, executors, administrators, successors, and assigns (the “Released Parties”) arising out of or resulting from any and all injuries or damages of any nature, including death, which (I)(my child) may suffer while taking part in the event or any activities connected with the event. I UNDERSTAND THAT THIS MEANS THAT I AGREE NOT TO SUE any or all of the Released Parties in connection with the event.

Consent also is hereby given to use (my)(my child's) name, picture, portrait, likeness, writings or biographical information (including, if applicable, neuromuscular disease diagnosis), and audiotape and/or videotape recordings and sound or silent motion pictures of (me)(my child) in any media for editorial, educational, promotional, and advertising purposes, for the solicitation of contributions, and for any other purpose in furtherance of the corporate purposes and objectives of MDA By completing this RSVP form, I certify that I have read the above and fully understand it, and that I am not relying on any statements or representations of any Released Party. This document shall be binding upon me, (my)(my child's) heirs, executors, administrators, assigns, and all legal guardians (of my child).