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 
(yyyy) 


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: 
  Neurology 
  Psychology 
  Pharmacist 
  Nursing 
  EMT 
  Other Healthcare Professional 
  Social Work 
  Accounting/Finance 
  Events 
  Fundraising 
  Insurance 
  Public Speaking 
  Social Media 
  Teaching 
  Website Design 
  Writing 


Languages Spoken
  ASL 
  French 
  Russian 
  Spanish 



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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