RareShare Webinar/Podcast Registration Form-Adrenomyeloneuropathy (AMN/ALD)
Register below to reserve your spot in the Webinar/Podcast sessions for June 14 2017
Will you attend the webinar or podcast *
First Name *
Your answer
Last Name
Your answer
What brings you to webinar or podcast series? Check all that apply.
Your Email (For the details about the webinar or live podcast, and then we will not contact you again [or store the email] unless you check that you want to hear more about us!)
Your answer
What is your phone number?
Your answer
If you would like to submit question for our panelists to answer, write them here:
Your answer
Will you be comfortable using phone/internet/computer during the podcast or webinar session?
We might feature your question. If so, would you be okay with us using your first name and last initial and where you are from when asking the question?
If so, country and/or state of residence:
Your answer
If you would like to hear more about RareShare or RGI, check yes and we will send you an email with more information!
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