Use this form to request membership to the FAPG website and mailing list.

	Become a website member (you will be able to post photos and news links on this site)
	Become a mailing list member (you will be added to the FAPG mailing list)
First Name:
Last Name:
Email Address:
Address:
City:
State/Province:
Zip Code:
Country:
Phone Number:
Children - name, birth year, type of ataxia: (only parents of ataxians are allowed to be members of the mailing list)