London Make a Move

Create Your Account
Create Your Page
Checkout

Joining team Mueller Family

I'd rather just register as an individual

Create account
Already have an account

Personal details

First Name *

Last Name *

Email address *

Password*

Mobile *

I'd like to be added to your email list to receive updates and news from Scleroderma Canada

Yes No

Postal address *

Address Line 1 *

Address Line 2 (opt)

City *

Postal Code *

Province/Territory *

Country *

Emergency Contact Details

Please provide us with an emergency contact

First Name

Last Name

Contact Number

Relationship to you

Organization details

Organization name

Event Waiver, Release of Liability and Indemnity Agreement

Notice of Filming and Photography

When you attend a Make a Move for Scleroderma event, you enter an area where photography, audio, and video recording may occur. By entering the event premises, you consent to such recording media and its release, publication, exhibition or reproduction.

I agree to the above waiver. *

Additional Information

Have you participated in Make a Move before? *

How are you connected to the scleroderma community? *

How did you hear about Make a Move? *

Joining team Mueller Family

Create account

Already have an account

Already have an account with us?

Personal details

Postal address *

Emergency Contact Details

Organization details

Event Waiver, Release of Liability and Indemnity Agreement

Additional Information

Get Involved

Fundraise

About