Yes, I want to become a member of the Spina Bifida Association of Delaware:
Name & Birthdate of Individual with Spina Bifida: ________________________________________
Name______________________________________
Address___________________________________
__________________________________________
__________________________________________
Phone (____)________________
Email Address_____________________________
Method of Payment:
Signature__________________________________
Make checks payable to "SBAD" (Spina Bifida Association of Delaware). SBAD is a tax exempt, non-profit organization. All donations are deductible.
PRINT OUT FORM ABOVE AND SEND WITH CHECK OR MONEY ORDER TO:
