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Erdheim-Chester Registration

 

The ECD Global Alliance believes that by joining together as a group, we will all be in a better position to fight this disease than if we do it all alone. Therefore, we ask that you provide the following information. NONE of this information will be passed on to any other groups or affiliations, your information will be held private. Once you provide this information someone will contact you via email as quickly as possible (usually within days at the longest). We hope you will join us.

First Name:        
Last Name:        

Patient Name:     (If different)
Street Address:  
City:                   
State/Province:    
Zip/Postal Code: 
Country:             
Phone:                
Email:                 

How affected by ECD? (Eg, patient, loved one, medical professional, etc.)

 

Please indicate how you found this site:

    Google search

    Yahoo search

    HAA (www.histio.org)

    NORD (www.raredisease.org)

    Suggested by medical personnel

    Other:

    No Answer



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Last updated: Dec 8, 2009