Pre-registration Form

Registration is easy! Just fill out the form and when you are done press send to register at the Lupus Alliance.
Or print this form and mail it to us at: Lupus Alliance, 26507 Harper Ave., St. Clair Shores, MI 48081 or Fax to
us at 586.775.8494

Event I am Registering For: 
Name:
Address:
City:
State:
Zip Code:
Telephone:
E-Mail 
Others Registering With Me:

 

Lupus Alliance of America, Michigan Indiana Affiliate 26507 Harper Ave, St. Clair Shores, MI 48081
Phone: 800.705.6677    Fax: 586.775.8494    Email: info@milupus.org