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MS Activists Survey

1. Please complete the following:

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Name:

 

 

   

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City/State/ZIP:

 

    

 

 

If you respond and have not already registered, you will receive periodic updates and communications from National MS Society.

 

 

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(Maximum response 255 chars, approx. 5 rows of text)

6.
Question - Not Required - Have any of these issues recently affected you? (Check all that apply)

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Question - Not Required - How would you like to make a difference? (Check all that apply)

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   Please leave this field empty