Volunteer Application
* Required Fields
Contact Information
* First Name 
* Last Name 
* Address 
  Address 2 
* City 
* State/Province 
* Zip/Postal Code 
* Country 
  Home Phone 
  Cell Phone 
* Email 
  If you are an individual with MG please prove the following: Year of Diagnosis 

Volunteer Information
  How did you hear about us? 
  Do you have any physical needs
that require special arrangements? 
  Year of Birth 
  I am interested in the following programs 
  I am a 

Expertise and Interests
  Please check all that apply: 
  Other Healthcare Professional 
  Social Work 
  Public Speaking 
  Social Media 
  Website Design 

Languages Spoken

Privacy Policy
We keep your personal information private and secure. When you submit this form, your name, contact information, and any additional information will be available only to our organization.

Contact Us: Myasthenia Gravis Foundation of America, Inc•• 355 Lexington Avenue, 15th Fl, New York, NY  10017 ••800-541-5454 ••mgfa@myasthenia.org

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