Support Group Registration Form

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Question - Required - What is your connection to ALS? (Select all that apply)
Please make between 1 and 5 selections from the choices below.

   


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Confidentiality:

* The Les Turner ALS Foundation group facilitators will never give out your information--even to another group member--without your permission. We encourage you, as a group member, to follow this rule as well.

* I will not share patient/family names or other identifying information with people outside of the group.

* I will not solicit for anything that is not Foundation-related, e.g. an offer to join your Walk team is okay, but a request to buy something you're selling is not okay.

 


Photo Release:

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Registration Information:

  (Required)

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Name:

 

 

   

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