Membership in the SRS Global Alliance is FREE and there are no required meetings or fees. The Silver Russell Syndrome Global Alliance is a network of patient support organizations and medical professionals throughout the world who support patients (children and adults) who have Silver Russell Syndrome [Russell Silver Syndrome].
Please refer to the CONSTITUTION of the SRS Global Alliance for complete details on the mission statement, membership benefits, structure, policies and procedures of the Alliance.
Application Form (please email to info@silverrussellsyndrome.org)
Global Alliance Application Form (if you are using this with language translation the content of the form is shown below in your language)
Constitution of the SRS Global Alliance
SILVER RUSSELL SYNDROME GLOBAL ALLIANCE
NEW MEMBER APPLICATION
Membership in the SRS Global Alliance is FREE and there are no required meetings or fees. The Silver Russell Syndrome Global Alliance is a network of patient support organizations and medical professionals throughout the world who support patients (children and adults) who have Silver Russell Syndrome [Russell Silver Syndrome].
Please refer to the CONSTITUTION of the SRS Global Alliance for complete details on the mission statement, membership benefits, structure, policies and procedures of the Alliance.
Organization Name: __________________________________________________________
Website Address: _____________________________________________________________
Organization Mailing Address: _________________________________________________
_______________________________________________________
Representative Name: __________________________________________________________
Representative email: __________________________________________________________
Is this a Facebook-Only Group: YES / NO Facebook Address _________________
IS this a formal organization: YES / NO
What country/geographic area does your organization cover? ________________________
What language does your group communicate with? ____________________
Approximately how many families are in your group? ____________________
I acknowledge that the information we have provided here is accurate and truthful. I acknowledge that on behalf of my organization, I have read the SRS Global Alliance Constitution in its entirety and accept full responsibility to abide by these requirements and policies.
I acknowledge that my failure to abide by the participation requirements and policies detailed in this Constitution may result in the revocation of my organization’s SRS Global Alliance membership privileges as well as other possible sanctions or censure, as detailed in the “Membership Withdrawals and Expulsion” section of the Constitution.
Signature for: __________________________________________
Any Additional information:
Please forward completed form to info@silverrussellsyndrome.org