Pediatric Vasculitis Registry (PedsVPPRN) Sign-up Form

PedsVPPRN LAUNCHING IN 2025!

Be the first to know! Sign up for our mailing list and you'll be notified once the PedsVPPRN is open for enrollment.

The Pediatric Vasculitis Registry is a new addition to the Vasculitis Patient-Powered Research Network (VPPRN), the research arm of the Vasculitis Foundation.

INSTRUCTIONS: You must be 18 years or older to complete this form. We can't collect contact information from anyone under 18 without parental consent. Please make sure all the information you provide is accurate. Your privacy is important to us, and your information will be kept confidential.

Question Title

* First Name

Question Title

* Last Name

Question Title

* Email Address

Question Title

* Alternate Email Address (if applicable)

Question Title

* Best Phone Number to Reach You At

Question Title

* I am a

Parent/Guardian of a child living with vasculitis

Adult patient living with vasculitis

Healthcare professional

Other (please specify)

Question Title

* OPTIONAL: How did you hear about the PedsVPPRN? Please select ALL that apply.

Vasculitis Patient-Powered Research Network (email blast / website)

Vasculitis Foundation (email blast / website / support groups)

Other Vasculitis Patient Support Group / Advocacy Organization

Family / Friend

Healthcare professional

Social media

Internet search

Word of mouth

Other (please specify)

By submitting this form, you are consenting to receive emails from the Pediatric Vasculitis Registry (PedsVPPRN) and the Vasculitis Foundation (VF). You can revoke your consent to receive emails at any time by notifying the VF by completing the VF Contact Us form.

100% of survey complete.