2023 RDW Interest Form

2023 Rare Disease Week Interest Form
Are you interested in representing the CMD Community at 2023 Rare Disease Week on Capitol Hill?

2023 Rare Disease Week, held February 28 to March 2, is sponsored by the EveryLife Foundation. Find information about the agenda on their website.

Please complete the form below and our staff will contact you with more details.

Questions about the Cure CMD Legislative Advocacy team? Contact us at advocacy@curecmd.org.
How many affected individuals (has CMD/LGMD) are there in your immediate family (including yourself, if applicable)?*

01234+
Please indicate the affected individual(s) CMD/LGMD Subtype:*

Collagen 6 (Ullrich/Bethlem)DystroglycanopathyLAMA2 (Merosin)Laminopathy (LMNA)SELENONUndiagnosedOther
Please indicate how many people in your family are planning to attend Rare Disease Week on Capitol Hill (including yourself and any professional caregivers):
Adults (Age 18 years or older)*
How many of these adults are professional caregivers (not members of your family)?*
Teens (Age 13-17 years)
Children (Age 2-12 years)
Infants (Age 0-23 months)
Total Number of Attendees (including yourself)
Your Name*

First NameLast Name
Your Email Address*
example@example.com
Your Home Address*

Street Address

Street Address Line 2

CityState/Province

Postal Code
Phone Number (Mobile Preferred)*
323-250-2399
How many days do you plan to attend?*

1 Day2 Days3 Days4 DaysAll the Days!
Please describe in just a few short sentences why you want to attend RDW.
Cure CMD will be offering a limited number of travel stipends for those attending RDW from outside of the local geographical area. Do you plan to apply for this stipend?

YesNoMaybe. Tell me more.I plan to only attend virtual events.
Should be Empty:

2023 Rare Disease Week Interest Form