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YOUR CAH INFORMATION - Please mark "unaffected" or write in "N/A" if doesn't apply.
PLEASE COMPLETE THE FOLLOWING INFORMATION ABOUT YOUR CHILDREN: Please mark "unaffected" or write in "N/A" if doesn't apply.
PLEASE COMPLETE THIS SECTION ABOUT YOUR CAH-AFFECTED RELATIVE/FRIEND: Please mark "unaffected" or write in "N/A" if doesn't apply.
IF YOU ARE A MEDICAL PROFESSIONAL, PLEASE TELL US ABOUT YOURSELF. (If not a medical professional, please mark N/A):
ADDITIONAL HELPFUL INFORMATION: Please mark box accordingly or write in "N/A" if doesn't apply.
Please check "Yes" in the box below if you would like to be contacted by a Support Group Leader in your area. Support Group Leaders are trained volunteers whose families are personally affected by CAH. They organize local speakers and events and can help to answer some of your CAH questions.
When this form is submitted you will become a member of the CARES community and have a CARES account. Please create a username and password for this account so that you can track all of your transactions with CARES, including shop purchases, event registrations, ticket purchases and donations. You will also be able to update your account contact information.
If you have established an account within our CARES Community Portal, please LOGIN.
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