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Neuromyelitis-Optica.net Advocate Interest Form
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Email
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Your email
What is your name? (first and last)
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Your answer
What is your email address?
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Your answer
What country do you live in?
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Your answer
What are your preferred pronouns?
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He/him
She/her
They/them
I'd prefer not to say
Other:
Are you at least 18 years of age?
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Yes
No
What is your social handle? (optional)
Your answer
Briefly tell us about yourself and your experience with NMO
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Your answer
Why do you want to be an advocate for Neuromyelitis-Optica.net?
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Your answer
Have you written or spoken about your journey with NMO anywhere? If so, please share the link below.
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Your answer
I understand this form is an interest form and someone will reach out to me if I might be a good fit as an advocate on Neuromyelitis-Opitca.net
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Yes
No
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