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Registration Form: Nutritional Support for People Diagnosed with TBRS, Sarada Bernstein MPH, RD
Event Timing: August 8, 2022, 5:00 pm - 6:00 pm EDT
Zoom link will be sent after registration is complete
Contact us at (845) 264 3016 or
jill@tbrsyndrome.org
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Email
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Your email
Name
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Your answer
Address
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Phone
Your answer
Are you or a loved one diagnosed with TBRS?
*
Yes
No
Maybe
Other:
Feel free to tell us about yourself
Your answer
When (approximately) were you or your loved one diagnosed?
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DD
/
YYYY
Name of diagnosed individual in your family:
Your answer
Date of birth of diagnosed individual:
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DD
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YYYY
Please comment here if you do not speak English and need translation to attend the meeting, or if you have other accessibility requirements:
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A copy of your responses will be emailed to the address you provided.
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