MDA Next Steps Seminars Interest Form

MDA’s Next Steps Seminars provide small group learning for the community at critical life stages including receiving a new diagnosis of a neuromuscular disease and transition to adulthood for youth living with a neuromuscular disease. These seminars are offered on an on-going basis. Once you complete this registration form, our team will be in touch with you regarding the next date for the seminar that is relevant to you/your family.

Contact Info:

First Name

Last Name

Address

City

State

Zip

Phone Number

Additional Information:

Relationship to person living with NMD

Diagnosis/Diagnosis of loved one:

What year did you/your loved one receive a diagnosis of neuromuscular disease?

Age of person living with NMD:

How would you like to receive the pre-work and learning materials?

What are you hoping to gain from this seminar?

Which Next Steps Seminar are you interested in attending?

Was this seminar recommended by a MDA Care Center?

If yes, which care center?

Are you interested in joining an MDA community group that meets once per month?

How did you hear about the Next Steps Seminars?

I am 18+ and agree to MDA's terms & conditions and privacy policy. (https://www.mda.org/about-mda-privacy-policy)

I agree

I understand and accept that my personal data will be collected as a result of my registration and participation in connection with this MDA Community Education program and will be used for future MDA communications.

I accept

All Next Steps Seminar attendees must be a member of MDA to participate. By completing this registration form, you and your child will be automatically registered as a member with MDA. There is no fee associated with your MDA membership. For more information, please visit mda.org/join-mda

Upon registering, you will receive an email that requires your response to participate in program. Please be looking for the email shortly after registering.

Contact Information