SB Connect groups foster meaningful connections among people and families impacted by Spina Bifida in local communities that are unserved or underserved by other Spina Bifida support organizations. Facilitated by volunteer members of the Spina Bifida community, SB Connect groups are free of cost and inclusive to the entire intergenerational community. This form is for people interested in starting an SB Connect group in their community. 


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* 1. Please type your full name

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* 2. Which of these describes you?

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* 3. Which is the city/region where you are interested in starting an SB Connect? Please list at least the city and state. 

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* 4. Is this area considered:

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* 5. What is the closest Spina Bifida support organization (SBA chapter or unaffiliated group)?

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* 6. How many people with Spina Bifida (adults and children) including yourself/child do you personally know in your area? Count only individuals with SB, not each of their family members.

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* 7. If there is something specific you'd like us to know about your knowledge of your local SB community, or your relationship with the people in your community, please share a little below. 

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* 8. What is the nearest Spina Bifida clinic? Please list the name of the hospital/clinic and location.

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* 9. Are you interested in being a facilitator for a group?

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* 10. If yes, what's your experience with Facebook? Please check all that apply.

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* 11. If yes, what's your experience with Zoom? Please check all that apply.

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* 12. Please share your email. This is so we can contact you about your interest. 

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