Join the National Spinal Cord Injury Association

The National
Spinal Cord
Injury Association

Join the NSCIA

NSCIA members are parents, siblings and friends. They are doctors, artists, students and businessmen. NSCIA's members are neither cripples, invalids nor patients. Our members are not home-bound, wheelchair-bound or bound to anything except living a fulfilling life.

Membership in NSCIA entitles you to priority service to the NSCIA Resource Center, a subscription to SCI Life and discounts on books, medication, travel, equipment, supplies and more!

New benefits now available to NSCIA members include:

Participation in Athena Neurosciences' discount Home Pharmacy Plan (800-528-4362)
"Absolute lowest price" domestic air travel fares and discounted international air costs through Eurolink Travel (call Tatiana Hirscht at 888-758-4950)
An MBNA affinity credit card embossed with NSCIA logo and low introductory interest rates (800-789-6262)

Please complete this membership form.
Because we currently cannot accept payments across the internet, your information will be appended to our database. Within a few minutes of submitting this form you will be emailed a Membership Form, complete with your information. When you receive the form, please print and mail it to NSCIA with your check or money order.

You must provide a valid email address.

NOTE: If you would like to pay by credit card (credit card payments also accepted via phone and fax) or do not have a valid email address, you may download the Membership Form in Word (.doc) or Rich Text (.rtf) formats.

MEMBERSHIP FORM Required fields are marked by an asterisk (*).
Name:*
Organization:
Address 1:*
Address 2:
City:*
State:*		Zip:*
Country:
Daytime Phone:*
E-mail:*
Age:


Type of Membership*
I don't want to join now but, I'd like to make a donation of:
Individual with spinal cord injury Level of Injury (e.g. C-4, T-12, L-1, etc.)	$25.00
Family Member		$25.00
Health Care Associate (Social Workers, PT, OT, RN)		$50.00
Professional (MD, PhD, JD)		$100.00
Foreign Member (funds drawn on US bank only)		$100.00
SCI Facility (Hospital, Clinic, Independent Living Center)		$100.00
Silver Organization Member (Organization/Corp. Budgets under $1 million)		$250.00
Gold Organization Member (Organization/Corp. Buget over $1 million)		$500.00
Platinum Organization Member		$1,000.00
In Touch With Kids (children with SCI, under 18 years old)		FREE! (for children only)

I would like to make an additional donation of:

Would you like to receive mailings from other organizations?
Occasionally, NSCIA makes its mailing list available to select individuals and companies for their mailings. If you would not like to receive these mailings, please indicate in the box provided.		Do not distribute my address

National Spinal Cord Injury Association
8300 Colesville Road
Suite 551
Silver Spring, Maryland 20910