DEBRA International Youth Council Membership
If you're filling out this form, you're interested in joining the DEBRA International Youth Council family.
Yay! Thank you for your interest! 

Our Vision
is to create a sense of community among youth around the world living with Epidermolysis Bullosa. We are committed to fostering an environment where patients can feel represented, valued, planned for, considered
and seen. 

Our Mission 
is to achieve this by providing a safe and supportive platform for youth to engage on, organized topics to discuss and explore together and the opportunity to meet and connect in-person.

We cant wait for you to join us!
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Your Basic Information:
Which pronoun/s do you identify best with? *
Name & Surname *
City & Country *
Email Address *
WhatsApp Contact Number (please include the international code) *
Date of Birth *
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YYYY
A little bit about you:
Which type of EB do you live with? *
Are you a member of your national DEBRA group?  *
Why would you like to join the Youth Council family?
What would you like to receive from the Youth Council?
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Important Information:
Please read the DEBRA International Privacy Policy.
Do you accept the DEBRA International Privacy Policy? *
Do you give consent for us to add you to our WhatsApp Community & Members group? *
Required
Do you give consent for us to keep a record of your information for our DEBRA International Supervisors & reporting purposes?

- No sensitive information will be publicly shared.
- All information will be stored safely.
 *
Do you give consent for us to use media from our online & in-person gatherings to advance our social media presence?

- No sensitive media will be publicly shared.
- All media will be stored safely.
 *
Do you declare that the above information you have provided in this form is correct & true? *
Just for us:
How did you hear about us? *
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