AADC Research Trust : Professional Registration Form

Professionals

In order to create a worldwide database of professionals interested in AADC we would like to invite you to register your details with The AADC Research Trust.

The AADC Research Trust fully respects professional/patient confidentiality and will not ask specific questions relating to any AADC affected child under your care. However, the questions below will help us collate an information database of where affected children are being diagnosed and what help may be available to them (this may include the translation of this web site)


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


	Name *
	Honours/Title/Qualifications
	Department
	Employers Name
	Address *
	*


	Post Code/Zip Code *
	Country *
	Tel *
	Fax
	Email *


Area of Experitise
	Scientific
	Paediatric
	Neurology
	Genetics
	Therapy
	if therapy - which field?
	Other

Please let us know why you are interested in AADC deficiency

	Do you currently care for or assist with the care of an AADC affected child?
	if yes please provide details - i.e. physio therapist, paediatrician…etc…

	How many children with AADC do you care for?

	What Country is the AADC affected child/children from?

	Is your interest in AADC of a scientific nature?
	if yes please provide details

	Are you currently working on any research that may be of interest to us or of benefit to a child with AADC deficiency?
	if yes please provide details of your research

	If relevant, can we pass on your details to AADC affected families?

	If relevant, can we pass on your details to other medical professionals?

* - Mandatory fields


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