Request to join AXYS Trisomy X/ Triple X/ XXX
In order to join this AXYS support group, we ask that you complete this form in its entirety. We ask for this information to keep our group safe and private.
First Name *
Your answer
Last Name *
Your answer
If different from the name provided above, how does your name appear on your Facebook profile? *
Your answer
What is your mailing address? Your complete address is required. *
If you are outside of the United States, please provide the address someone from the US would use to send mail to you.
Your answer
Please tell us a little bit about your interest in joining the group. What brings you to us? *
Your answer
What is your email address? Please provide the email address that you use to log in to Facebook. We will need to get in touch with you to give you the link to the secret group. If you do not provide the email address you use to log into Facebook, your invitation will not work. *
Your answer
Do you agree to follow the group rules? *
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