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Jett Foundation Educational Roundtable Registration
Jett Foundation's Educational Roundtables are your opportunity to learn more about Duchenne. Pharmaceutical companies in the Duchenne space, Duchenne expert clinicians and researchers, and Jett Foundation representatives, will present to an audience of patients and families on a myriad of topics including upcoming and ongoing Duchenne clinical trials, treatment and standard of care, physical therapy, genetics, and Jett Foundation direct service programs.

Please join us for a day of education, all at no cost to attend! We provide childcare and lunch. Looking forward to seeing you there!

For any additional questions, please contact danielle@jettfoundation.org or call us at (781)-585-5566

Which roundtable(s) are you registering for? (You can register for more than one)?
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First Name
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Last Name
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Mailing Address
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City/Town
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State
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Zip/Postal Code
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Country
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Email Address
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Phone Number
Your answer
Company Name and Title (if Presenter/Pharmaceutical Company) then go directly to SUBMIT at bottom of the form.
Your answer
What is your relationship to the patient diagnosed with Duchenne muscular dystrophy (Duchenne)?
What is the name of the patient diagnosed with Duchenne ?
Your answer
How old is the patient diagnosed with Duchenne?
Your answer
What type of mutation does the person diagnosed with Duchenne have?
If exon deletion(s) or duplication(s) , please specify exon(s) numbers(s)
Your answer
Has the patient diagnosed with Duchenne participated in a clinical trial?
Is the patient amenable to Exondys 51? If so, is the patient receiving Exondys 51?
Your answer
If you are comfortable sharing, where does the patient diagnosed with Duchenne receive their medical care?
Your answer
If you are comfortable sharing, has your physician provided information on upcoming clinical trials?
Is the person diagnosed with Duchenne on a steroid regimen?
Will the patient diagnosed with Duchenne be attending with you?
What would you like to learn more about in relation to clinical trials?
Do you need childcare?
List names and ages of children who need childcare
Your answer
How many total people in your group are attending (so we can order lunch)
Your answer
Does Jett Foundation have permission to contact you about future Duchenne event or educational sessions?
By clicking YES below, I hereby authorize Jett Foundation to publish photos of myself and or my son/daughter or ward on the official Jett Foundation website and social media pages and/or for our brochures and/or newsletters. The photos will be used to members of the Duchenne community of the educational programs that Jett Foundation offers. I stipulate by signing below that the photos not be identified in any way with personal information other than first names. (i.e., last name, address, phone number or any other identifying information). The photos will not be used for any other purpose than the stated purpose above. Not all photos will be used; only those deemed most advantageous for the purpose intended and that most accurately depict the subject matter.
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