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Thank you for sharing your information with the ALD community!

Please note that we do not collect personal health identifiers like name, birthday, address, phone number and so forth. All data you provide will be screened to ensure there are no identifiers, shortened if necessary and then shared on the website. If you would like your information to be used for official research purposes, please use the contact page to get in touch and we will help connect you to the appropriate resources.

The first four fields are required and the rest are optional. Please fill out for each individual.