It's easy becoming a member of the Tri-State Multiple Sclerosis Association. Simply complete one of the applications listed below  in the format you can use or fill out the on-line form.

Membership form in Adobe Acrobat

Download Acrobat Reader if needed 

Membership form in Microsoft Word

After completing any of the above applications, fax  to 812-423-5650 or e-mail to Director@Tristate.ms or mail to:

Tri-State Multiple Sclerosis Association, Inc.
971 C. Kenmore Drive
Evansville, IN, 47714

Instructions on how to Attach a Document to an E-mail.

	Full Name :   Address1 :   Address2 :   City :   State :   Zip :   Home Telephone :   Work Telephone :   Email Address :   Diagnosis :   Date :   Physician :   MS Drug Therapies :   Avonex® Provigil® Rebif® Betaseron® Copaxone® Novantrone® Relationship to Patient :   Self Family Member Care Giver Friend Other

Tristate.ms is the sole owner of and the only organization that uses the information collected on this site. We will not sell, share, or rent this information to others under any circumstances.