Interested in our Research

Name*

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Last

Are you filling this out for yourself, or on behalf of someone else?*

Are you interested in being contacted about upcoming research studies that you or your family member may qualify for?*

Yes

Participant Name*

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Last

Date of Birth*

day

month

year

Gender*

Has this individual been diagnoses with a neuromuscular disorder?*

Yes

Unknown

If so, what type of neuromuscular disorder have you/they been diagnoses with?*

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