Myotonic Dystrophy Foundation

Sign Up Today!

We encourage you to Join the MDF community.  Each individual or household signing up receives a 'Family Welcome Pack' that includes Dr. Peter Harper's book Myotonic Dystrophy: The Facts, printed materials from the MDF Web site, a medical alert wallet card and medical history sheet, and "Cure Myotonic Dystrophy" bracelets and MDF pens. You can also ask to receive our quarterly newsletter that includes articles on myotonic dystrophy by respected authors as well as updates on the latest medical advances, progress of the MDF, and much more. 

Please fill out the form below and click submit.

• Title (Mr., Mrs., Dr., Rev., etc.)
• First Name (s)
• Last Name (s)
• Suffix (M.D., Ph.D.,etc.)
• Company/Organization
• Address 1
• Address 2
• City
• State
• Zip/Postal Code
• Country
• Home Phone Number
• Office Phone Number
• Cell Phone Number
• Email Address
•  
• Receive our e-newsletter? (Email address required)
•   Yes    No
•  I would like to receive a "Family Empowerment Pack" which includes detailed medical information about myotonic dystrophy including two books on DM, an emergency alert card, medical history sheet and MDF bracelets and pens. (Also available for Therapy Providers and Healthcare Professionals).
•   Yes, send me a complete family empowerment pack (only 1 complete family empowerment pack per sign up please)
•    Yes, send me only parts of the empowerment pack that are important to me (specify below)
• Send me (The Facts, MDF printed booklet, DM book, alert cards, medical history sheets, bracelets, pens, etc. - please specify the quantity)
•  
• I would like to sign up to volunteer my time with the MDF
•   Yes, add me to your list of volunteers for the MDF
• Volunteer Preferences (list any preferences you have for volunteer work such as event planning, event volunteer, administrative assistant, support group leader, other, not sure, etc.)
•  
• Please tell us about your relationship with myotonic dystrophy
• Select Self or Family Member Friend of Family Healthcare Professional Therapy Provider (PT, OT, SLP, etc.) Social Services Professional Researcher Teacher Student Other (Please specify below)

• Other (please specify below)
•  
• Do you attend a support group for myotonic dystrophy?

• Support Group Name (please specify below)
•  
• How did you learn about the Myotonic Dystrophy Foundation?
• Select Google Search Yahoo! Search Other Search (specify below) Facebook Personal Blog Internet Ad for MDF (specify where below) Referred by Family Member Referred by Friend Referred by MDA Other (specify below)

• Other (please specify below)
• Other Comments (add any other comments for the MDF staff)
  
• 
• Security Code (Please enter the code above)

 

 

Note: If you are having trouble entering the security code above, please send an email to admin@myotonic.org