Aicardi Goutieres Syndrome Advocacy Association

By registering with our contact list, you agree to allow us to contact you with AGSAA updates, newsletters, and information that may be of interest to families with AGS. We will make every effort to cross-post information to all AGSAA social media channels. By supplying us with your mailing address, we may be able to connect you with other AGS families, opportunities, and experts in your area. Information you share about your relationship to AGS will better help us coordinate our communications and facilitate connections between affected families. Any and all information you share will never be shared or sold outside of the AGSAA without your permission. Only AGSAA admins and coordinators (family support or research) will have the ability to see your information or contact you. You may unsubscribe at any time, and we will respect your privacy and right to have your information deleted from our list.

* indications requises

Email Address *

First Name

Last Name

AGS Affected Individuals' Names

Ex. "John Smith, Jane Doe". Share the names of the AGS affected individuals you have a relationship to. Please enter multiple names separated by commas if applicable.

Relationship to AGS

Select your relationship to the AGS Affected Individuals entered. Select "Community Ally" if you have no relationship to an AGS affected individual.

Address

Rue Ligne d'adresse 2 Ville État Code postal Pays

Phone Number

Be sure to include relevant country and area codes.

Facebook Profile URL

Help us correlate membership with our Facebook Support Group. If you view your FB profile by clicking your name or picture, what is your profile URL (e.g. https://www.facebook.com/patrick.winters.54)?