International Adhesions Society

 

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Joining the International Adhesions Society

Please fill out the following form:

Name
Address
City
ST / Prov
Postal Code
Country
Phone
Fax
Email

Gender

female male
Brief description of your adhesions problem

I am interested in starting a support group in my area.
yes no

Do you have any special skills/experience that may be useful in running a patient support group?
yes no

Explain:


I would be interested in being contacted regarding clinical trials relating to my condition
yes no

I would be interested in receiving other information relating to my condition and general updates from the IAS.
yes no

I am interested in volunteering, please let me know how I can help.
yes no

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