All information is confidential to IPPSO. Names, addresses, e-mail addresses and other information that may reveal your identity are not for public information, unless you grant permission as an individual. Any information about your PPS symptoms used for research into Post-Polio Syndrome will remain anonymous. This is not a scientific survey, however, nor do we claim it to be.
This form is an effort to accumulate as much information as possible about our family and polio survivors around the world, their illness and assist in research as the need may arise. We ask that you complete this form and submit it to us.
We understand that it might take a little of your time to complete it and we apologize for any inconvenience, but the more information we can ascertain, the more we are able to assist our members and the general public about polio/PPS. Thank you for your time and effort in completing the form.
In order to help us meet our financial obligations we would ask that you consider making an annual $20.00 donation. Anything beyond that would be of great benefit to many. You can send your check or money order made out to IPPSO to:
c/o Kathy Husmann
423 First Avenue South
Hibbing, MN 55746 (You will receive a receipt).
Alternatively, you can use our PayPal account by clicking here, and then click the 'Make a donation' button on the page that then opens. It is fast, free and secure, and convenient, as you do not need to do anything else than filling out a form! It is also tax deductible as we are a 501 (c) 3 non-profit organization.
Please fill out any information that pertains to you and be sure to highlight your answer on mutiple-choice questions.
The items marked with an asterisk (*) are required information.