PALS / FALS Support Membership Site

This membership is currently free for everyone who chooses to sign up to check out the available information.

The membership site is specifically geared to PALS (People diagnosed with ALS-MND-Lou Gehrig’s Disease), families and caregivers, and their core support team, including medical professionals.

If you are a PALS, please include your Diagnosis Date.  If you are on a PALS Support Team, or Caregiver/Spouse/Partner, or Family Member/Friend, then please include the Diagnosis Date of the individual you assist.  Since this is a required field, please input 01/11/1961 if this field is not applicable to you.  Thanks!

Price:

Free

First Name:* First Name Required

Last Name:* Last Name Required

Connection with ALS:* Connection with ALS is Required

PALS (Person diagnosed w ALS) CALS (Caregiver/Spouse/Partner) FALS (Family/Friend) MP (Medical Professional) Other (Please add explanation below.)

'Other' Connection with ALS: 'Other' Connection with ALS is not valid

Diagnosis Date
(REMINDER: If you are a PALS, please include your Diagnosis Date. If you are on a PALS Support Team, or Caregiver, then please include the Diagnosis Date of the individual you assist. Since this is a required field, please input 01/11/1961 if this field is not applicable to you. Thanks!):* Diagnosis Date
(REMINDER: If you are a PALS, please include your Diagnosis Date. If you are on a PALS Support Team, or Caregiver, then please include the Diagnosis Date of the individual you assist. Since this is a required field, please input 01/11/1961 if this field is not applicable to you. Thanks!) is Required

Where do you live, or are located - City, State/Province, Country?:* Where do you live, or are located - City, State/Province, Country? is Required

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

I have read and agree to the Terms Of Service*

 

Please fix the errors above