National MS Society Pennsylvania Advocacy

Some advocates share their own personal stories as a person with MS, a caregiver or a family member. These examples help the Society express the challenges real people face while accessing health care, long-term care or other important services.

Stories, with permission of the contributor, are used as supporting documentation for lawmakers introducing bills or to raise awareness about issues through media coverage.

Please share your story by filling out the form below.

Contact Information:

Name:

Title	First Required	Middle Required	Last Required	Suffix

Email: Required

Street 1: Required

Street 2:

City/State/ZIP:

City Required	State/ProvinceRequired	ZIP/Postal CodeRequired

Country:

Phone Number:

Occupation:

Gender: Required

What is your relationship to MS?

(Select one of the available choices or enter a different value.)

Share your story.

If you have any photos, you are asked to email them to Jennifer.Strayer@nmss.org. Do you have any photos to include with your story?

Do you have any personal relationships with any legislators?

If so, please describe the relationship. Be sure to include the names of who you know and how you know them.

(Maximum response 255 chars, approx. 5 rows of text)

Contact me about becoming an MS activist.

I hereby authorize the Pennsylvania Chapter Advocacy Network to use the above information for legislative advocacy and/or promotional purposes in printed materials such as press releases.

We thank you for sharing your story.