What Do You Want the World to Know About Spina Bifida?

Is there something you want others to know about Spina Bifida? We'd love to connect with you, share your story and possibly feature you on our social media during Spina Bifida Awareness Month this October.

If you have any questions or would like assistance, please reach out at communications@sbaa.org.

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* 1. First Name

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* 2. Last Name

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* 3. Email Address

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* 4. Are you interested in sharing a short story, quote, or picture about what you want others to know about Spina Bifida? This could include what you might want a teacher, neighbor, family member, or your local legislator to know. It's a moment for you to let others know about Spina Bifida.

Your answer will be shared on the Spina Bifida Association's social channels.

Yes

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* 5. What is your relationship with Spina Bifida?

I have Spina Bifida

Parent of a child with Spina Bifida

Family member of someone with Spina Bifida

Care partner of someone with Spina Bifida

Health care professional

Other

Other (please specify)

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* 6. Are you aware of any Spina Bifida groups in your area? You do not need to be associated with a group or chapter to share your story.

Yes

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* 7. If you answered yes above, what Spina Bifida groups are you aware of?

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* 8. What is it that you would like the world to know about Spina Bifida?

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* 9. Please upload any photos we can accompany the story with.

PNG, JPG, JPEG file types only.

Choose File

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* 10. Is there anything else that you'd like us to know? If yes, please share below.

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* 11. By sharing information and/or images, I hereby authorize the Spina Bifida Association (SBA) to the use the information including my likeness and image in any and all publications, educational materials, research, marketing, advertising, news media, and Web materials. I agree that SBA does not owe me any compensation. I further understand and agree that these materials may be kept on file and used by SBA for potential future purposes and further agree to release SBA from any and all liability arising from or in connection with the taking, use, publication, or dissemination of such materials.

Yes, I authorize SBA to use the material I am providing.