Join the movement

"This is ~~AFM~~ Me" is an educational awareness campaign that challenges the social issues and understanding around rare diseases & disabilities and aims to break the silence by supporting people diagnosed with Acute Flaccid Myelitis (AFM) to tell their own stories.

Please fill out this form to join the movement. We will send you instructions on how to record your personal story via email after completing the form.

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General SRNA Permission Form

I hereby grant permission to the Siegel Rare Neuroimmune Association (SRNA) to utilize my (or my children's) name, biographical material, appearance, performance or voice in any and all manner and media throughout the world for the purpose of promoting, reporting or publicizing SRNA. By signing this form, I also permit SRNA to use any material or parts of materials submitted to SRNA such as stories, articles, essays, blogs for the purpose of promoting, reporting or publicizing SRNA. I understand that no royalty, fees or any other compensation shall become payable to me by reason of such release.

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