Become a member of Cure SMA Foundation of IndiaPlease fill up the following form for a one time life time registration & membership with Cure SMA Foundation of India. Membership entitles you to receive our newsletters, latest updates on events and work in other areas. You also can become connected to other families and individuals affected by SMA globally. To become a member, please fill out this online form for submission electronically – or print it out the downloadable membership form and mail or courier it to us at the head office. Send an email to info@curesmaindia.org/curesmaindia@gmail.com OR courier to our address given under contact. You will be given a unique membership ID. We ask for a one time registration fees of INR500/- and monthly membership fees of INR1000/- per family to help cover printing, mailing, organizing events and administrative costs. The membership fees may be paid quarterly as well @3000/- per quarter. Instructions for making a donation will show after you click ‘Submit.’ We ask one member of the family to fill up the membership form and get a membership ID. *UsernameUsername can not be left blank.Please enter valid data.This username is already registered, please choose another one.This username is invalid. Please enter a valid username.*PasswordPassword can not be left blank.Please enter valid data.Please enter at least 6 characters.Strength: Very WeakNumber of SMA Warrior/s in your family Husband, Wife, Children up to 4Text field can not be left blank.Please enter valid data.SMA Warrior/s Name/sText field can not be left blank.Please enter valid data.Your relationship with SMA WarriorText field can not be left blank.Please enter valid data.Please give a brief description about your family w.r.t SMA Warrior/s :Text field can not be left blank.Please enter valid data.NameGenderDOBSMA TypeSMA WarriorRelationship with warrior Name 1Text field can not be left blank.Please enter valid data.Select OptionMaleFemalePlease select atleast one option.Please enter valid data. DOB 1Please select date.Invalid Date.Select OptionType 1Type 2Type 3Please select atleast one option.Please enter valid data.Select OptionYesNoPlease select atleast one option.Please enter valid data. Relationship 1Text field can not be left blank.Please enter valid data. Name 2Text field can not be left blank.Please enter valid data.Select OptionMaleFemalePlease select atleast one option.Please enter valid data. DOB 2Please select date.Invalid Date.Select OptionType 1Type 2Type 3Please select atleast one option.Please enter valid data.Select OptionYesNoPlease select atleast one option.Please enter valid data. Relationship 2Text field can not be left blank.Please enter valid data. Name 3Text field can not be left blank.Please enter valid data.Select OptionMaleFemalePlease select atleast one option.Please enter valid data. DOB 3Please select date.Invalid Date.Select OptionType 1Type 2Type 3Please select atleast one option.Please enter valid data.Select OptionYesNoPlease select atleast one option.Please enter valid data. Relationship 3Text field can not be left blank.Please enter valid data.Now, please complete the form below: *First NameFirst Name can not be left blank.Please enter valid data.This first name is invalid. Please enter a valid first name.*Last NameLast Name can not be left blank.Please enter valid data.This last name is invalid. Please enter a valid last name.*Email AddressEmail Address can not be left blank.Please enter valid email address.Please enter valid email address.This email is already registered, please choose another one.AddressPlease enter valid data.AptCan not be left blank.Please enter valid data.*CityCan not be left blank.Please enter valid data.*StateCan not be left blank.Please enter valid data.Postal CodeCan not be left blank.Please enter valid data.Home PhoneCan not be left blank.Please enter valid data.Work PhoneCan not be left blank.Please enter valid data.Cell PhoneCan not be left blank.Please enter valid data.Please upload pictures (Family picture & other pictures of SMA Warrior/s) and diagnosis reports : Drop file here or click to select.Drop file here or click to select.Please select file.Invalid file selected.Invalid file selected.SubmitDone(Use Cropper to set image and use mouse scroller for zoom image.)