Membership Application

Please use the form below to submit your 2013 Membership Application (Valid 1/1/13-12/31/13). You will be redirected to a page where you can pay your membership fee via PayPal.

Name
Address
City	State Zipcode
Email
Phone
Cell Phone
Relationship to individual with Spina Bifida
Person w/Spina Bifida
Date of Birth (00/00/0000)	/ /
Person w/Spina Bifida Email
Please check if you are interested in volunteering	Phone calls – Connect with Individuals & Families Serve on Special Event Planning Committees Assist in Fundraising Hospital Visits Communications – Newsletter & Publicity
Amount Due	$15 Individual Adult with Spina Bifida (over 18 living independently) $35 Family
Comments

 

Benifits of Membership

Receive invitations to members only events, like the Christmas Party, and discounts on fee based events.

Eligibility to apply to the Financial Assistance Fund.

Meet other individuals & families affected by Spina Bifida.

Build lifelong friendships.

Participate in fun events.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Spina Bifida Kansas City
P.O. Box 1041
Belton, Missouri 64012
816.277.9087
info@sbkc.org