Cure SMA Teen & Adult Support Package Request Form

 

Please fill out the form below to request a Cure SMA Support Package. Upon submitting the request form below we will ship out your support package in the order it was received.  Please email supportpackage@curesma.org with any questions.  Also, please note we are unable to ship to PO boxes.

Eligibility Criteria:
Must be diagnosed with SMA and be 13 years of age or older. Must live within the US.

  Contact Information:

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Date of Birth:

 


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Question - Required - Diagnosis Date




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