Corpal Registration

PLEASE READ BEFORE REGISTERING: This forum is for the use of members who wish share experiences and offer each other support for those affected in some way by Agenesis of the Corpus Callosum and Aicardi Syndrome. Once you have submitted your registration we will endeavour to activate your request within 48 hours. You will then receive instructions on how to enter the forum. Please be aware when entering your information, your first name and surname will be shown on the forum as your user name. If you want your user name to be different, on logging into the message board, please go to member control panel then, Edit Profile, you will then be able to change your name and surname.

General Information
First Name:
Surname:
Your Email Address:
Confirm Email Address:
Requested Password:
Confirm Password:
Your Date Of Birth:
Address	House Name:
	House Number:
	Line 1:
	Line 2:
	Town/City:
	County:
	Postcode:
	Country/Region:
Telephone Number (including std code):
Mobile Telephone:
Your Gender:		Male Female
Why are you interested in ACC?
Are you the person affected with ACC?		Yes No
If not, what relation are you to the person affected?
What is the name of the person affected with ACC?
Age Group At Diagnosis:
Reason for Joining
Why do you want to join Corpal?
Disclaimer
I agree to use this forum with respect and thought for others on the forum at all times. I agree not to use swear words. I agree not to use this message board for my religious or political views at any time. I agree to report any posting that I believe to be of an offensive, abusive or spam mail nature. Email details to info@corpal.org.uk stating FORUM POSTING CONCERN. Corpal has the right to remove any posting that is of an offensive nature or believe to be a spam mail. This forum is provided for members to share experiences and support each other who have been affected in some way by Agenesis of the Corpus Callosum or Aicardi Syndrome. Always check with your doctor if you have any concerns about the condition or treatment. Corpal is not responsible or liable, directly or indirectly for any form of damages whatsoever resulting from the use or (misuse)) of information in or implied by the information on this Forum site. Corpal cannot be held responsible for any inconvenience caused by subsequent changes. I accept the terms and conditions set out by Corpal

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