Join to receive urea cycle disorder treatment and research updates, information and educational resources, help and support.

Membership Benefits to families with urea cycle disorders

We're happy you are joining us in the fight to conquer urea cycle disorders.  NUCDF is a volunteer non-profit organization of families, friends and medical professionals dedicated to the identification, treatment, and cure of Urea Cycle Disorders. Our vision is a world where no child or adult suffers from UCD.  The benefits of membership are priceless - you can help save lives and make breakthroughs possible.

If you or your family is affected by UCD, membership benefits alsoinclude our newsletter with treatment and research updates, our networking programs, our annual conference, as well as personalized support and educational resources. Sharing information on this form about your experiences with the disorder helps the understanding of outcomes and prevalence of the disorders, and helps focus research efforts.

Please complete the following information and press "Submit Form" to transmit the information.  You will then be directed to a page where you can make a membership contribution through a secure server using Visa, MasterCard, American Express or Discover. A membership contribution is never a condition of membership, so you can complete the submission without making a contribution, but we do appreciate and need your support to achieve our mission. If you'd like to mail this form with a personal check, please print this form and mail it along with your contribution to:

  NUCDF
  75 S. Grand Ave.
  Pasadena, CA 91105

Please note: NUCDF takes your privacy very seriously.  We will never release information to any outside party without your explicit written consent.

Name Title
Department   Organization
Street Address   Address (con't)
City   State/Province
Zip Code/Postal Code   Country
Home Phone Work Phone
EMail      
Professional Membership   Family - Disorder
 
Preference for Receiving Newsletter   EMail address for Newsletter
Completing the following questionnaire is optional. However, it will assist us in understanding and supporting the needs of our urea cycle families and determining prevalence and outcome of the disorders.
Do you have a child that has been diagnosed with a Urea Cycle Disorder? Yes No
If you answered 'Yes' to question A, please proceed to question B. If you answered 'No', why have you decided to join the NUCDF?
B. Please complete the following information regarding all of your children, including those not affected by UCDs:
Child #1   Type of Disorder:
Age at Time of Diagnosis:
Is this child Living? Yes No   Current Age: Date of Birth:
Year of Death Age at Death: Cause of Death:
Child #2   Type of Disorder:
Age at Time of Diagnosis:
Is this child Living? Yes No   Current Age: Date of Birth:
Year of Death Age at Death: Cause of Death:
Child #3   Type of Disorder:
Age at Time of Diagnosis:
Is this child Living? Yes No   Current Age: Date of Birth:
Year of Death Age at Death: Cause of Death:
If you have been diagnosed with a urea cycle disorder:
Type of Disorder:   Age at Diagnosis: Current Age:
Our goal is to educate medical professionals and provide update information about new treatments, tests, etc. Please provide your physician's contact information to be included on the physician mailing list:
D. Name of treating geneticist/metabolic specialist:
Name   Title
Department   University/Hospital
Street Address   Address (con't)
City   State/Province
Zip/Postal Code   Country
Phone   Fax
EMail   Web Site
 
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NUCDF. Copyright (C) 2013 National Urea Cycle Disorder Foundation. All Rights Reserved.

Revised: 3/17/2013