🌟 Express Proclamation Toolkit

What It Is!

The Express Proclamation Toolkit makes it simple to request a proclamation for Moebius Syndrome Awareness Day (January 24) from your mayor and/or governor. Instead of downloading and mailing documents yourself, just fill out our secure online form — we’ll prepare your proclamation request and send it directly to your leaders on your behalf.

📬 We’ll mail copies to your city’s mayor and your state’s governor. You’ll also receive a copy by email.

⚠️ Please note: This service is currently available only in the United States.

Why Use the Express Form

Fast & Easy — One form replaces multiple steps.
Personalized — Your story is included in the official request.
Stronger Impact — Professionally prepared letters are more likely to be approved.

How to Fill Out the Form

Enter your contact details so we can personalize the letter and send you a copy.
Tell us your city and state so we know where to send the proclamation request.
Share your story by answering the detailed questions. The more heartfelt and specific your answers, the greater the chance your proclamation will be approved.
(Optional) Upload a photo of yourself or your loved one with Moebius Syndrome.
Give consent for us to prepare and send your proclamation.
Submit the form by pressing the submit button.

That’s it — we’ll take it from there!

Need Help?

If you have any questions while filling out the form, please reach out:
📧 tim@mfoms.org
📱 540 219 1248 Text only please!

We’re happy to help.

Express Proclamation Form

Section 1: Your Contact Information

1. First name

Last name

2. Email

3. Phone

4.Address

Section 2: Proclamation Details

(Tell us where you’d like the proclamation sent) 5. City (for the Mayor’s office) 6. State (for the Governor’s office) 7. Do you want us to send this proclamation to:

5. Mayor only

6. Governor only

Both Mayor and Governor

Section 3: Tell Us Your Story

(Your answers will be included in the cover letter to your mayor/governor. Please write in full sentences and be as detailed and heartfelt as possible — a strong story greatly increases the chance of approval.)

8. Who in your family or community is living with Moebius Syndrome? (Example: “My daughter Emma, age 7, was born with Moebius Syndrome and has overcome…”)

9. Tell us about their journey with Moebius Syndrome. (Include challenges, milestones, or achievements — what makes their story unique?)

10. What is the most important thing you want your mayor/governor to know about living with Moebius Syndrome? (Example: daily realities, the courage it takes, or the need for greater awareness.)

11. Why is Moebius Syndrome Awareness Day (January 24) important to you and your family? (Explain why recognition matters to you personally.)

12. What message of hope or awareness would you like to share with your community? (This required question ensures every letter ends on an inspiring, persuasive note.)

Section 4: Photo Upload

13. Upload a photo of yourself or your loved one with Moebius Syndrome (JPG/PNG).

Section 5: Consent & Agreement

I give permission for MFOMS to use my story and/or photo in awareness materials.

I understand that MFOMS will prepare and mail the proclamation request on my behalf.