Contact information form for the MAPK8ip3 family group
We ask anyone who would like to join the group email list and/or private Facebook group to complete this form. Someone will be in contact soon after and any questions can be directed to Answers on this form are only visible to families in our group.
Sign in to Google to save your progress. Learn more
Name *
Email address *
Country you reside in *
Your child's name *
Your child's birth year (i.e, 2015) *
Optional: Your child's specific variant information (this can be found on your  child's genetic report, usually begins with a c.____ or p.____). This would allow you to connect with other families with the exact MAPK8ip3 gene variant if you wish.
Are you interested in joining Zoom calls with the group (we meet every 3-4 months)? *
Are you interested in joining our private Facebook group? *
Optional: If you want to join our private Facebook group, what is your Facebook profile name so we can send you an invite?
Optional: Any other questions?
Clear form
Never submit passwords through Google Forms.
This form was created inside of Anne Jones. Report Abuse