Survey - Caregivers Registration - The ALS Association Greater Chicago Chapter

Once a registered user with The ALS Association Greater Chicago Chapter, you have the opportunity to update your contact information and personal preferences. Be sure to save your username and password so you can login to your account at anytime. The more information you share, the better our chapter can customize your experience according to your preferences you select and thus communicate our up to date research, chapter news, events and much more in the best way for you.

The ALS Association Greater Chicago Chapter values the privacy and security of our constituents. Please visit our privacy policy for more information.

Create Your Account:

*

Name:

Title	First Required	Middle Required	Last Required	Suffix

*

Email: Required

*

Street 1: Required

Street 2:

*

City/State/ZIP:

City Required	State Required	ZIP Required

Country:

*

Phone Number: Required

If you respond and have not already registered, you will receive periodic updates and communications from The ALS Association.

Keep me logged in. What's this?

Please enter a user name and password for logging in when you return. You can use this password to update your information or receive personalized content.

*	User Name: Required	5 to 60 characters
*	Password: Required	12 to 99 characters
*	Repeat Password: Required

*

Question - Required - Please tell us about your ALS connection:

*

Question - Required - Please provide the name of the ALS patient you are currently caring for

Question - Not Required - Please select from the list below your areas of interest:

	Athletic Fundraising events and information
	Create your own fundraising event
	Honor or memorial funds
	Information and topics specific to living with ALS
	Monthly communications and periodic updates from our chapter.
	Public policy efforts
	Research
	Volunteer opportunities
	Walk to Defeat ALS events
	Ways to support The ALS Association