ALS Association

 

Register with Our Chapter

 

To become eligible for The ALS Association programs and services a person must have a diagnosis of ALS, PLS, or PMA and register with our Chapter. You can register online using this form, or by calling our office at 612-672-0484 or Toll Free at 888-672-0484 and speaking with one of our Care Services staff.

If you complete the online registration, someone from our Care Services Department will contact you with more information.

 

The following set of questions are about the person diagnosed with ALS.

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Please complete the information below if it is different from above. 

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Question - Not Required - Do you have any issues with the following:

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Question - Not Required - Current Symptoms:

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Question - Not Required - Would you like to receive the monthly newsletter from The ALS Association, MN/ND/SD Chapter

 

Terms and Conditions

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