Supporter session registration form
Thanks for expressing an interest in being part of our supporter sessions. It is your opportunity to learn more about research and ask questions about the developing science and new treatments. By submitting this form, you agree to join our email mailing list. We'll only send you information related to Spinal Research. Your privacy is important to us and we process your personal data in accordance with the UK GDPR and our
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. You can unsubscribe at any time by clicking the link in the footer of our emails. For more information about our privacy practices, please visit our website.
Your details
First Name
Last Name
Email
Mobile
I'm happy to be contacted by
Phone
Text message
Your connection to Spinal Research
Connection to Spinal Research
Please select...
Family Member Injured
Friend Injured
Have An Injury
Medical Profesional
Recovered From SCI
Researcher
No Connection
Injury level
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Paraplegic
Quadraplegic
Injury severity
Please select...
--None--
Complete
Incomplete
How injury occurred
Please select...
--None--
Accident at home
Medical complications
Road traffic accident
Spinal stroke
Sport accident
Other
Year Injured
Mobility impairment
Please select...
--None--
Manual wheelchair
Electric wheelchair
Walker
Mailing list
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Webinar session mailing list
I would like to receive emails from Spinal Research about latest research news, opportunities to get involved, and ways to fundraise to advance a cure.
Contact Information