AADC Research Trust : Affected Family Registration

Family

The AADC Research Trust is working to improve the life of all AADC affected children wherever they may be in the world.

As we respect your privacy, at this initial stage, we will only require a few personal details with regard to you and your affected child, and would ask you to kindly complete the following form:


Forum Access
Please use this section to indicate that you would like access to our forum.
	Request forum login
(Forum login details will be emailed when approved.)
	Forum Username
	Password


Your details/About the Parent/Carer
	Name
	Address



	Post Code/Zip Code
	Country
	Tel
	Email *

	Can we contact you?

Creating an AADC Database

Please indicate here if we can send you a questionnaire requesting more detailed information about how AADC affects you and your child.


Please indicate here if we can share information that you have provided with medical professionals who are directly involved with AADC research.


About the child
	Name
	Address (if different from above)



	Post Code/Zip Code
	Country

	Age of Child
	Age AADC was diagnosed
	Previous Incorrect Diagnosis (if any)

* - Mandatory fields


disclaimer : privacy statement : acknowledgements : press office
The AADC Research Trust is a UK Registered Charity No. 1114367 © Copyright AADC Research Trust 2006