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MNM Registration for person with MS

1. By completing this confidential form, you are registering yourself with the National MS Society as a person with multiple sclerosis. You will receive information about our programs and services, as well as the latest news about treatments and research. If you would prefer to speak to someone directly, you may also register over the phone by calling the Upper Midwest Chapter at 612-335-7900 or 800-582-5296 (v/tdd).

If you have previously registered, please login here to prepopulate your information.

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Name:

 

 

 

 

 

         

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City/State/ZIP:

 

    

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Date of Birth:

 

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

 

 

What's this?

Please enter a username and password that you can use when you return. You can use this password to update your information or receive personalized content.

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5 to 60 characters

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5 to 20 characters

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2.
Question - Not Required - I am interested in receiving information about the following:


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5. Physician(s) you see for MS:
(Select one of the available choices or enter a different value.)



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7. What is your primary language?
(Select one of the available choices or enter a different value.)



8. What is your ethnicity?
(Select one of the available choices or enter a different value.)



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   Please leave this field empty