PRDPF! Webinar 007 - Registration Form

1. Survey for Participants - Help us to understand the audience needs

Thank you for expressing interest in attending the Webinar run by Putting Rare Diseases Patients First! So that we can understand the potential audience it would be helpful if you could respond to the following questions. The information will be treated in strictest confidence and will never be shared with other organizations or groups.

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* 1. Title

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* 2. What is your First Name?

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* 3. What is your surname?

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* 4. What is your gender?

Female

Male

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* 5. Enter the Email address for the Webex login information to be sent to.

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* 6. Do you yourself have a rare disease?

Yes

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* 7. Does your child have a rare disease?

Yes

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* 8. Are you a professional patient advocate for patients with rare diseases?

Yes

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* 9. Why is this Webinar of interest to you?

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* 10. Would you like to receive updates about other PRDPF! Webinars?

Yes

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* 11. How did you find out about this Webinar?

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* 12. Would the organization that you represent be interested in sponsoring this Webinar?

Yes

Perhaps we would be interested in sponsoring future Webinars