Current Members: If you are a current member please do not fill out this form. For changes in your membership or other needs, you must write to the Message Board Moderator. Need help? Read the Membership Terms and Conditions.
Skip to main content. New Members: Please fill out and submit the application.
Please Note. We shall hold your name, street address, telephone number and email address in strictest confidence. Completion and submission of this form to our web site implicitly gives us your permission to utilize your other information, such as gender, age, location to develop demographics about Corneal Dystrophy. Your postal address may be used to send you important information.
Please ensure that you complete all fields completely and accurately. Each application is reviewed by a person and calfornia checks may be performed on your information.
Deliberately incorrect or incomplete information will invalidate your application and can affect your eligibility for membership. We cannot inform you of email address errors. Secondary Street Address Not the same street again, Not a different street.
This califorjia optional for required additional addressing information required when your street address has more than one line of information ONLY. This provides a way for us to send a text message to you if there is an issue with your membership.
A friend or relative has Corneal Dystrophy. Leave this field blank.