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Become a Patient Representative
Thank you for your interest in become a patient representative with CTF Engage.
Our application cycle has closed.
We will soon be looking to grow this program, but are unfortunately only able to take a limited number of applicants at this time. Please know that we appreciate your interest and will keep your information for our next cycle in 2024.
If you have any questions, please direct them to
engage@ctf.org
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* Indicates required question
What is your first name?
*
Your answer
What is your last name?
*
Your answer
What is your email address?
*
Your answer
What is your cell phone number?
Your answer
What is your zip code (US)? If international, please list your country.
Your answer
What is your connection to NF?
*
I have NF
I am a caregiver to a person with NF
I am a family member of a person with NF
I am a friend of a person with NF
I do not have a direct connect to NF
Other:
Required
What type of NF ?
*
NF1 - neurofibromatosis type 1
NF2 - NF2-related schwannomatosis (formerly called neurofibromatosis type 2)
SWN - schwannomatosis (any type except NF2-related)
Not Sure
Not Applicable
What is your ethnic background?
Asian
Black/African American
Multiracial
Hispanic/Latin
American Indian/Alaska Native
White/Caucasian
I prefer not to say
Other:
Clear selection
Were you previously onboarded as a Patient Representative?
Yes
No
Maybe
Clear selection
Are you currently involved in any other CTF programs? If so, which ones?
Your answer
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