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Register Your Stroke Support Group

 

If you submit a group called Stroke Support Group, we will add the meeting place name, as defined on this form, to your group name.

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  Please enter the group leader contact information - mailing address, email and phone number are for internal purposes only.

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Name:

 

 

   

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City/State/ZIP:

 

    

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

 


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Group Activities: 

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Question - Required - What does your group provide? Select all that apply.
Please make between 1 and 12 selections from the choices below.

 

(Maximum response 255 chars, approx. 5 rows of text)

 

Group Type: 

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Question - Required - Which category (or categories) best describes your group?
Please make between 1 and 4 selections from the choices below.

 

(Maximum response 255 chars, approx. 5 rows of text)

 

Group Specialty: 

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Question - Required - Which category (or categories) best describes your group?
Please make between 1 and 8 selections from the choices below.

 

StrokeSmart® Magazine:

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Submitting this form indicates that you give National Stroke Association permission to post all data from this form on the National Stroke Association website (excluding those items marked for internal use only). 

If you have any questions or concerns, please contact Valerie Siebert-Thomas by email at supportgroups@stroke.org.  

   Please leave this field empty