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* 1. Organization Name

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* 2. Disease(s) served by your organization

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* 3. First name

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* 4. Last name

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* 5. Title

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* 6. State

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* 7. Zip code

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* 8. Email address

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* 9. Organization's phone number

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* 10. Does your organization have paid staff?

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* 11. What resources or services would be helpful to you in achieving your organization's mission?

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* 12. Congress has passed legislation allowing more patient input in the FDA's review process. How familiar are you with the FDA's regulatory process for reviewing and approving drugs for rare diseases?

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* 13. What do you believe are the main clinical or regulatory challenges of the current FDA regulatory process in the development of treatments for your disease?

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* 14. If there were ONE thing you believe needs to change about legislative and regulatory policy, that you feel the EveryLife Foundation should focus on in our next CureTheProcess campaign, what would it be and why?

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* 15. Please indicate what types of communication you would like to receive from our organization:

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* 16. THANK YOU for taking the time to let us know more about you and what issues you feel are important! If you have a question or comment, please use the space below:

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