Sickle Cell Warriors, Inc. Member Database
This database is created exclusively for use by Sickle Cell Warriors, Inc. Your information will not be shared with, or sold to, any third parties without your express consent. We respect your privacy. You will be contacted via email with more details, participation information, and sickle cell related events in your area. You will also receive a monthly newsletter from Sickle Cell Warriors. You can opt-out at any time.
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What is your email address? *
This is the email address that all your communications from Sickle Cell Warriors will be directed to.
First Name *
Last Name *
Country of Residence *
State of Residence *
City of Residence *
How old are you? *
How are you impacted by sickle cell? *
If you are the parent how old is/are your Warrior(s)?
If you are a Warrior, what is your diagnosis (e.g. SS, SC, etc.)?
What is your phone number?
What is your website?
You can include the direct link to your Facebook or Twitter account if you do not have your own website.
Are you currently affiliated with any Sickle Cell organizations in your area? *
If you answered yes to the previous question, which organization are you involved with?
Are you interested in helping to plan Sickle Cell Warrior activities in your city? *
Are you interested in receiving emails about opportunities to participate in sickle cell research studies? *
Will you be attending the 2014 Sickle Cell Community Gathering & Education Symposium? *
Any Comments or Questions?
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