Hispanic/Latinx MS Experience Summit

Email Address *

First Name*

Last Name*

Address1*

Address2

City*

Country*

State/Province *

Zip/Postal Code *

Phone Number *

Suffix

Preferred Name

What is your personal connection to MS? (select all that apply)

I have MS

I may have MS

My child has MS

My spouse or partner has MS

My parent has MS

My friend or other relative has MS

I lost someone I care about who had MS

I am a carepartner of a person with MS

No personal connection, I support the mission

My connection is not listed

I prefer not to say

Gender Identity

Race or Ethnicity (select all that apply)

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latina/Latino/Latinx

Middle Eastern or North African

Native Hawaiian or Pacific Islander

White

My race/ethnicity is not listed

I prefer not to say

Are you a Veteran of the United States Armed Forces?

What is your preferred language?

How have you engaged with the National MS Society in the past? (select all that apply)

This was my first time

Visited the website

Attended a program

Connected with a MS Navigator (received 1 on 1 support)

Attended a self-help group

Attended a fundraising event (e.g. Walk MS or Luncheon)

Volunteered

Donated

Other

Please rate your feeling of the National MS Society as a trusted source of support.

How likely is it that you would recommend the National MS Society to a friend or colleague?

Terms of Participation

The personal data you provide will be used for your registration in an event. By completing this enrollment form, you agree to the National Multiple Sclerosis Society Terms of Use and 6Connex Data Collection Consent.

Additionally, 6Connex would like to introduce you to other event participants who share your interests. If you consent, we will use the information you provide along with information about your visit (content you viewed, rooms you visited, and similar data) to identify other participants with whom you may want to interact.

The personal data you provide will be used to register you for an event. By completing this registration form, you accept the Terms of Use for null and the Participant Terms for 6Connex.

Yes, I understand that my information will be processed and shared with the aforementioned parties in order to process my registration.

No, I do not want my information processed and shared with the aforementioned parties and understand I will not be registered.

Registration