CT SCIA - Valley Shore YMCA Community FES Program

Community FES Program Sign Up / Interest

Please use the form below to sign up if you are interested in participating in or would like more information regarding the Community FES Program at the Valley Shore YMCA. Our program coordinators will reach out to you shortly with the information you provide below.

First Name

Last Name

Address

Address 2

City

State

Zip

Daytime Phone

Describe Disability :

Para

Quad

No Disability

Choose Not to Say

Other

if "other" please specify :

Level of Injury / Date of Onset (if applicable):

Have you used FES, or received FES training in a clinical setting?:

Yes

If Yes, please describe:

Comments / special concerns you would like to make us aware of:

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Click the button below to complete your registration:

If you have any questions or concerns you may contact:

Geoff Matesky
Community FES Program Coordinator
E: geoff@sciact.org
P: 860-227-6493

The Spinal Cord Injury Association of Connecticut

Thanks for visiting!

Wheeling and Able!

CT SCIA - Valley Shore YMCA Community FES Program

Community FES Program Sign Up / Interest