Become a TMA member

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Transverse Myelitis Association
Membership Form

If you are interested in becoming a member of the TMA, receiving information about TM, or contributing to the efforts of the TMA, please fill out this form.

If you are having trouble using this form, send mail with the required information directly to membership@myelitis.org instead.

There is currently no cost to join, but your tax-deducible donation to help defray cost of mailing material is greatly appreciated! The future of TMA depends on membership support of the Association's general operational activities and services. Click here to see how to make a contribution.

If you are a representative from a company that has a commercial interest in the Transverse Myelitis community, please do not fill out this membership form. For information about The Transverse Myelitis Association, please contact:

Sandy Siegel
1787 Sutter Parkway
Powell, OH 43065-8806
phone: (614)766-1806

Choose one of the following options:

New Member
Change Existing Information

Please provide the following contact information:
Required fields are in bold.
If within the US, Canada, or US Territories, please leave the County/Region/Territory field blank.

First Name
Last Name/Family
Organization
Postal Address 1
Postal Address 2
City/Town
State/Province	US, Canada, or US Territories
County/Region/Territory	International ONLY
Zip/Postal Code
Country
Please include all the details requested, so that we can reach you in the event we have problems reaching you at postal address
Phone	US & Canada use (555)555-5555 format
E-mail

Select any of the following that apply:

Person with Transverse Myelitis (TM)
Person with Acute Disseminated Encephalomyelitis (ADEM)
Person with Devics Disease (Neuromyelitis Optica or NMO)
Person with Optic Neuritis
Person with another neurological condition
Other Disorder:
I am a Family member of the person with this condition
My relationship to the person:
I am a physician or medical professional treating a person
I belong to an Organization treating a person with this condition

I would be able to be a translator contact for non-English speaking members?
If so, which languages can you translate to/from English?

Contact information will be included in a directory sent to members for the purpose of being able to contact members in ones' area for support and information.
Check if you DO NOT want your contact information included in the member directory. The TMA does not share your contact information with anyone outside of the TMA membership. If you check the box to not include your information in the membership directory, you will not receive a directory. The support group leaders from the state and country support groups also use the directory information to contact new members and to invite members to support group meetings. If you are not listed in the directory, you will not be contacted by local area support groups