Survey - Welcome to the ALS Association's Online Community

Welcome to The ALS Association’s online community. Thank you for agreeing to take a few moments to answer our short survey about your connection to ALS. Your answers will help us provide you with information that is most meaningful for you.

Question - Not Required - 1. What is your connection to ALS?

Question - Not Required - 2. What information would be most helpful to you?

	Information about activities and events in my local community
	Information about how I can advocate to create better laws and policies affecting thousands of people with ALS and their families
	Information about how I can raise funds to support The ALS Association
	Information about how I can volunteer
	Information designed to support caregivers, families, and people with ALS
	Information on the latest scientific research related to ALS

Question - Not Required - 3. What is the best way for you to receive information about ALS?

	Email on my laptop or desktop
	Email on my mobile device or tablet
	Postal mail
	Visiting websites
	Being contacted by my local chapter
	Facebook
	Twitter
	LinkedIn

Question - Not Required - Do you want to learn more about services, events, and ways to help in your community?

Yes! Please send me information on local activities.

Please update your contact information. (optional)

Name:

First Required	Last Required

Street 1:

Street 2:

City/State/ZIP:

City	State	ZIP

Country:

Phone Number:

If you respond and have not already registered, you will receive periodic updates and communications from The ALS Association Florida Chapter.

Yes, I would like to receive postal mail from The ALS Association Florida Chapter

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