GRSBA Membership Application

GRSBA Membership Application Form

All current members are considered active, therefore, membership renewal is not necessary. General membership is open to any individual.

Membership Application

Member Information

1. Name
1. Name
First
Last
2. Address
2. Address
City
State/Province
Zip/Postal
4. Can you receive text messages?
6. I hereby apply for membership of the Greater Rochester New York Spina Bifida Association (GRSBA) and declare that the information provided herein is accurate and up to date:
7. Please indicate whether you are interested in serving on a GRSBA Committee: Check all that apply
Checkboxes
Checkboxes

8. I have read and understand the mission of GRSBA (Mission Statement and By-Laws can be found on the GRSBA website: www.GRSBA.Org).