MSF Events Supplies Request

Moebius Syndrome Foundation Supplies Request

Request for promotional supplies for awareness events
Requests are due at least 30 days prior to the event date.

Questions? Please email us at events@moebiussyndrome.org or call (844) MOEBIUS ext. 704 or (844) 663-2487 ext. 704. Thank you!
Your Name (or Contact Person if Different)

First NameLast Name
Mailing Address to send supplies (MUST be located within the United States)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Phone Number

Area CodePhone Number
Contact E-mail
- Name of Awareness Event
- Location of Awareness Event
- Date and Time of Event (leave blank if TBD)
  
  MonthDayYearHourMinutesAM/PM Option
- Number of Adults Expected to Attend
- Number of Children Expected to Attend
- Description of Event.
- Promotional Supplies – Would you like us to send you any awareness materials for educational purposes? Quantities are limited so availability may vary. *Note: in 2026, for school awareness events, we can send enough supplies for up to 25 students, based on availability at the time of the request.
- Is there a fundraising component to this event? (Not required in order to receive supplies. Please put N/A if this does not apply to your event.)
- What additional support and resources can the Foundation provide for your event? (select as many as needed)
- Post Event follow up
- We may feature your event in Moebius Sydrome Foundation marketing and communications such as the monthly e-newsletter, the website, social media pages, and biannual printed newsletter.
- Are you able to email pictures and/or video of the event to us afterwards? This is optional, but helps us to spread awareness about how donations used to purchase supplies such as these supports our efforts to raise awareness. Please email any photos, videos, or comments to events@moebiussyndrome.org.
- If you do not hear back from us with an email updating you on the status of your request within 7 days of submission, please email us at events@moebiussyndrome.org.
- Should be Empty:

Moebius Syndrome Foundation Supplies Request

Post Event follow up

If you do not hear back from us with an email updating you on the status of your request within 7 days of submission, please email us at events@moebiussyndrome.org.