Designing Our Lives with Myasthenia Gravis

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Spring 2025 Cohort: Application Closes on 1/31/25

Email *

First Name *

Last Name *

Preferred Name or Nickname

Phone Number *

Pronouns

She/Her

He/Him

They/Them

Just use my name.

Other:

What brings you here to this application? *

Mailing Address

Are you a patient living with myasthenia gravis? *

Yes

Undiagnosed

What antibodies were detected? *

Anti-acetylcholine receptor (AChR)

Anti-muscle-specific kinase (MuSK)

Low-density lipoprotein receptor-related protein 4 (LRP4)

Seronegative

Unknown

Required

Best Way to Contact You *

Phone (Calling)

Phone (Texting)

Required

What is your country of residence? *

United States of America

Other:

In what time zone do you live? *

Pacific Time

Mountain Time

Central Time

Eastern Time

Other:

Please vote for your preferred day/time for our *LIVE* sessions? (Select any times that you're available or suggest a different day/time by using the "Other" option.) *

Mondays at 4 p.m. - 5:15 p.m. PST / 5 p.m. - 6:15 p.m. MST / 6 p.m. - 7:15 p.m. CST / 7 p.m. - 8:15 p.m. EST

Tuesdays at 4 p.m. - 5:15 p.m. PST / 5 p.m. - 6:15 p.m. MST / 6 p.m. - 7:15 p.m. CST / 7 p.m. - 8:15 p.m. EST

Wednesdays at 4 p.m. - 5:15 p.m. PST / 5 p.m. - 6:15 p.m. MST / 6 p.m. - 7:15 p.m. CST / 7 p.m. - 8:15 p.m. EST

Thursdays at 4 p.m. - 5:15 p.m. PST / 5 p.m. - 6:15 p.m. MST / 6 p.m. - 7:15 p.m. CST / 7 p.m. - 8:15 p.m. EST

Mondays at 5 p.m. - 6:15 p.m. PST / 6 p.m. - 7:15 p.m. MST / 7 p.m. - 8:15 p.m. CST / 8 p.m. - 9:15 p.m. EST

Tuesdays at 5 p.m. - 6:15 p.m. PST / 6 p.m. - 7:15 p.m. MST / 7 p.m. - 8:15 p.m. CST / 8 p.m. - 9:15 p.m. EST

Wednesdays at 5 p.m. - 6:15 p.m. PST / 6 p.m. - 7:15 p.m. MST / 7 p.m. - 8:15 p.m. CST / 8 p.m. - 9:15 p.m. EST

Tuesdays at 8:00 a.m. - 9:15 p.m. PST / 9 a.m. - 10:15 a.m. MST / 10 a.m. - 11:15 a.m. CST / 11:00 a.m. - 12:15 p.m. EST

Wednesdays at 8:00 a.m. - 9:15 p.m. PST / 9 a.m. - 10:15 a.m. MST / 10 a.m. - 11:15 a.m. CST / 11:00 a.m. - 12:15 p.m. EST

Thursdays at 8:00 a.m. - 9:15 p.m. PST / 9 a.m. - 10:15 a.m. MST / 10 a.m. - 11:15 a.m. CST / 11:00 a.m. - 12:15 p.m. EST

Tuesdays at 9:00 a.m. - 10:15 a.m. PST / 10:00 a.m. - 11:15 a.m. MST / 11:00 a.m. - 12:15 p.m. CST / 12:00 p.m. - 1:15 p.m. EST

Wednesdays at 9:00 a.m. - 10:15 a.m. PST / 10:00 a.m. - 11:15 a.m. MST / 11:00 a.m. - 12:15 p.m. CST / 12:00 p.m. - 1:15 p.m EST

Thursdays at 9:00 a.m. - 10:15 a.m. PST / 10:00 a.m. - 11:15 a.m. MST / 11:00 a.m. - 12:15 p.m. CST / 12:00 p.m. - 1:15 p.m. EST

Fridays at 9:00 a.m. - 10:15 a.m. PST / 10:00 a.m. - 11:15 a.m. MST / 11:00 a.m. - 12:15 p.m. CST / 12:00 p.m. - 1:15 p.m. EST

Fridays at 10:00 a.m. - 11:15 a.m. PST / 11:00 a.m. - 12:15 p.m. MST / 12:00 p.m. - 1:15 p.m. CST / 12:00 p.m. - 1:15 p.m. EST

Saturdays at 9:00 a.m. - 10:15 a.m. PST / 10:00 a.m. - 11:15 a.m. MST / 11:00 a.m. - 12:15 p.m. CST / 12:00 p.m. - 1:15 p.m. EST

Other:

Required

If selected for the upcoming cohort, what are you hoping to take away from this experience? *

What are the biggest challenges for you as someone living with myasthenia gravis?

More About You (Please share as much or as little as you feel comfortable sharing.)

This group is a 6-month, virtual program that meets live (over Zoom) 3 times per month (75 minutes). If selected to be a participant in this cohort, are you willing and able to commit to showing up to the group sessions for the entirety of the program? *

YES!

No, thank you. This group is not a fit for me at this time.

Yes, but... (I have some circumstances that I need to work out logistically.)

Other:

Send me a copy of my responses.

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