SCS Membership Application Form

Spinal Cord Society Membership Application Form

Spinal Cord Society is a non-profit corporation under the laws of Minnesota, with a 501 C-3 designation.

U.S. Yearly Membership $30.00 - All Foreign Subscriptions $45.00 (U.S.)

                       NAME _________________________________________________________ BIRTH DATE____________

                                        ^{Last
First
Middle}

                         ADDRESS_____________________________________________________ INJURY DATE____________

                         CITY___________________ STATE________ COUNTRY______________ INJURY LEVEL____________

                         ZIP CODE _____________                                                                    PHONE ( _____ )____________________

q-New Member q-Family Member of Injured q-Spinal Cord Injured
q-Friend of Injured q-Gift Subscription q-Subscription Renewal

Please send this application form with check to:
SPINAL CORD SOCIETY
19051 County Highway 1
Fergus Falls, Minnesota 56537-7609

As a member of Spinal Cord Society, you are supporting spinal cord injury research

and will be updated monthly on its progress through the SCS newsletter.

(MEMBERSHIPS & DONATIONS are tax-deductible)

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