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Questionnaire for the Transverse Myelitis Association
Please refer to the instructions above before filling out the survey.
When you have completed the survey, please return it to:
Transverse Myelitis Association
c/o Sanford J. Siegel
1787 Sutter Parkway, Powell, Ohio 43065.
__X_ Check if this is the address to which you would like TMA materials
mailed.
Name (of person with transverse myelitis): ________________John Yung
Address (Street, P.O. Box):___________________________2683 West Spruce
City, State, Zip Code: _______________________________Fresno, CA 93711
Home Phone (include area code): --_____________________209-431-8288
E-Mail Address: _________________________
___ Check if this is the address to which you would like TMA materials
mailed.
(Fill out the name and relationship spaces only, if address is the same
as
above)
Name (if filling out form for person with transverse myelitis):
__George Yung
Address (Street, P.O. Box):___________________________9627 West Window
Way
City, State, Zip Code: _______________________________Columbia, MD
21046-2035
Home Phone (include area code): --_____________________301-725-5017
E-Mail Address: ___________________________________symbiotc(AT)erols.com
Relationship to person with transverse myelitis: _____________brother
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31. Please provide your opinions as to the goals and activities in
which the Transverse Myelitis Association should adopt and participate:
TMA Goal: Maintain the most comprehensive information available on
Transverse Myelitis and provide access to appropriate levels information
to those that need it - professionals and patients alike.
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32. If you are interested in volunteering your assistance to TMA,
please identify in what activities you would be interested in
contributing your time and talents.
As a computer engineer, I offer my time and services.
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