You are here: Home » Membership Application Form

Membership Application

The Greater New York Chapter of the National Spinal Cord Injury Association (NYCSCIA) is pleased to
extend a free membership to persons with spinal cord injury or disease.

BENEFITS INCLUDE:

Subscription to the NSCIA quarterly magazine SCI Life
PVA Resource Guide, Priority to Peer Mentor Network
Monthly Electronic Newsletter
Access to the National SCI Hotline
Access to the National Resource Center’s Library
Discounts and early notification of NSCIA conventions and conferences
Plus much more…

Please complete this form

Fields with an * are required.
*First Name:
*Last Name:
*Address
Organization
Telephone Number (Home)
Telephone Number (Work or Cell)
*E-mail Address
If you are Spinal Cord Injured
Level of Injury
Date Injured
Age When Injured
Date of Birth:
Rehab. Hospital Attended
For more information please call 212-659-9369 or email NYCspinal@NYCspinal.org.