Membership Application

Apply for Member Access

To maintain a private, secure network free from commercial solicitations, our team verifies every applicant before granting community access.

Identity Verification Requirement

Your contact details are kept strictly confidential.

1. CONFIDENTIAL IDENTITY & VERIFICATION

Real Legal Full Name *

🔒 Your real name remains private with our vetting team and is never shown publicly in the community.

Community Display Name / Pseudonym (Optional)

Choose a pseudonym or nickname if you prefer anonymity in public channels and discussions. Defaults to your first name if left blank.

Date of Birth *

Required to verify adult membership (18+).

Contact Phone Number *

Your contact details are kept strictly confidential.

I confirm that I am a Jewish woman living with or navigating a diagnosis of Multiple Sclerosis. *

How did you hear about us? *

2. ACCOUNT CREDENTIALS

Email Address *

Password *

Confirm Password *

3. DIAGNOSIS & ADDRESS DETAILS

Diagnosis Type *

Year of Diagnosis *

Street Address (Optional / Private)

Used confidentially to send member comfort care packages.

City *

State / Province / County *

ZIP / Postal Code *

Country *

What kind of peer support or topics are you most looking for? (Optional)

I agree to community safety guidelines: to treat all members with dignity, respect individual treatment choices, and refrain from selling products, soliciting, or sharing unsolicited medical claims. *

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