Write 2 Unite Participation Form

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Please complete this form so that you can be paired with someone to connect with in our community. By submitting this form you are registering for the program, consenting to share your information with The Aneurysm and AVM Foundation's Write to Unite program in order to provide information and connect you to another member of the community.

Email *

Name *

Preferred Email *

Age Range *

Elementary Age (8-11 years old)

Middle School Age (12 - 14 years old)

High School Age (15 - 18 years old)

Adult

Condition of Interest *

AVM

Aneurysm

Both

Areas of Interest *

Survivor

Caregiver - (Parent, Sibling, Immediate family)

Family/Friend of Survivor

Family/Friend of those who have passed away

Required

Communication of Choice *

Social Media

Writing/Postal Mail

Required

Communication of Choice (Continued): If you answerd social media above, please add your handle below. TAAF uses IG,TW and FB. If you would like to receive postal mail, please list your address.

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