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* 1. Name:

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* 2. Please indicate the age range you fall into.

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* 3. Do you reside in the US?

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* 4. Which state do you reside in?

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* 5. Have you been diagnosed with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA)?

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* 6. When were you diagnosed? (month and year)

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* 7. Have you previously or currently been treated with avacopan (Tavneos®)?

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* 8. If currently on avacopan, when did you start taking?

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* 9. What was your overall experience while taking avacopan?

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* 10. Would you be interested in further sharing your experience? Please select all that applies:

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* 11. If you are interested in sharing your story with the industry partner that makes Tavneos® (Amgen), do you give the VF permission to share your contact information?

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* 12. Contact Information:

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