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*Name
*Mailing Address
*City
*State  
*Zip code
Group Name
Meeting Location
*Phone\n"); document.write(" \n"); document.write(" \n"); document.write(" \n"); document.write(" \n"); document.write(" \n"); document.write(" \n"); document.write(" \n"); document.write(" \n"); document.write(" \n"); document.write(" \n"); document.write("
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*E-mail
*Verify E-mail
Group Website
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Check here to have e-mail/website listed on referral sheet
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*Are you taking over an existing group?
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Yes
No, I am starting a new group
No, I am updating my group information
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If yes, who was the previous leader?
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*Is there a fee or suggested donation to attend your support group?
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YesNo
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If yes, please indicate amount per year:
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*My support group is affiliated with (check all that apply):
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Arthritis Foundation
American Chronic Pain Association
Clinic
Hospital
None of the above
Other:
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*How often are group meetings?
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*Average number of people at meetings?
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*Does your support group mail or distribute any published materials?
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YesNo
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If yes, please indicate what types of materials:
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Additional comments:
The Fibromyalgia Network Journal is copyrighted and cannot be legally copied and/or redistributed. Only support group leaders who have paid Membership fees to the Fibromyalgia Network are allowed to reprint up to two articles per year with prior written permission. Reprint requests should be mailed, e-mailed, or faxed to us. There is no cost to register your group.

\n"); document.write("By submitting this form, I give the Fibromyalgia Network permission to add my name, meeting location, and phone number to its referral network. In addition, I acknowledge that referrals are added and removed at the discretion of Fibromyalgia Network. I believe that fibromyalgia syndrome (FMS) and chronic fatigue syndrome (CFS) fall into the same family of conditions and I am eager to assist people with either diagnosis.

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