Join Our Family Directory

AHC individual's (child or adult) full name(Required)

First Last

Date of Birth(Required)

Father's Name(Required)

First Last

Father's Email(Required)

Father's Cell phone(Required)

Mother's Name(Required)

First Last

Mother's Email(Required)

Mother's Cell phone(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Marital status(Required)

married (M)

Divorced (D)

Age at Diagnosis

Specify – "ATP1A3 – (specific mutation) ATP1A2 or No mutation"

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