Get Involved

Contact Registry

The M-CM Network Contact Registry is used to inform individuals with M-CM and their guardians about:

• opportunities to participate in research
• opportunities to contribute data
• discoveries about M-CM that may impact care decisions

Registrants' contact information will not be shared with anyone outside of the M-CM Network.  Registrants will be provided with contact information about relevant research and survey efforts. These initiatives will include our own internal projects as well as the projects of outside researchers.

We may use aggregate data from the contact registry to publish statistics about the incidence of M-CM.  For example, we may use contact registry data to say how many people have M-CM, what their age ranges are and how they are distributed geographically.

We will not use this list for M-CM Network marketing or fundraising. If our policy about acceptable use of our contact registry ever changes, you will be notified.  You may opt-out of the contact registry at any time by contacting us.

Person with M-CM

First Name

Last Name

Date of Birth

Month January February March April May June July August September October November December

Place of Birth (include country)

Person to be Contacted

First Name

Last Name

Email

Phone

Mailing Address (include country)

If English is not your native language and you would require translation services to answer medical questions in English, please provide your preferred language.

Language

Agreement

I agree to allow M-CM Network to store information about myself and/or my dependent with M-CM so that I may be contacted with information about the availability of research opportunities. I may also receive updates about medical discoveries that may impact care decisions about M-CM. I understand that my data may be used in aggregate to compile and publish statistics about the incidence of M-CM.