Join us to let the world know that Kids Have Strokes, Too!

Childhood Stroke Awareness Day
Saturday, May 2, 2009

 Childhood Stroke Awareness Project Interest Form

Please fill in all fields.  We'll send an email with childhood stroke awareness information to your email address.  CHASA does not sell or share your personal information with anyone. We will only send one or two emails. We realize that your time is important! 


Name


Street Address


City, State, Zip


Phone


E-mail address

Would you like to participate in a Childhood Stroke Awareness Walk-a-thon this year? yes no

Do you know a pediatric stroke survivor? yes no

If yes, please tell us how you know this little survivor (parent, grandparent, friend of family, etc.)

 
Networking is important in helping our cause.  Please list any media, businesses, professionals, or others that you are connected with in your community who might be interested in helping with or sponsoring our cause.
 

Please make sure that messages from chasa.org are allowed by your email host.

Thank you for showing interest in the Children's Hemiplegia and Stroke Association Childhood Stroke Awareness projects. With your help, we can tell the world that Kids Have Strokes, Too!