Membership Application for Fuchs’ Friends Online Support Group

Current Members please note.  This form is for persons who are not yet members.  For changes in your membership or other needs, you must write to the Message Board Moderator.

Please Note:  We shall hold your surname 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 Fuchs’. 

If you have a Set-top box or other system without a mouse click on the ‘If No Mouse’ below for instructions for navigating around a form:

Other Notes:

• Do NOT submit multiple requests; we have no way to handle them.  Only the first request received will be considered.  All fields must be completed properly to ensure your registration. Incomplete requests will cause an error message to display.
• Please use caps AND lower case for proper capitalization of items except email address and zip code (e.g, Robert, not robert or ROBERT).

This link is for help on this form only  

First or Given Name of the Applicant

Last or Surname that same person

An incorrect email address will cause your application to be rejected.

E-mail Address

City

State or Province

Zip or Postal Code

 (5 digits for US)

Country

Age

   Of person who has Fuchs’

Gender (of the person who has Fuchs’)

 Male             Female 

Year Diagnosed (yyyy)

Pick ONLY ONE of the Radio Buttons Below

  I have Fuchs’ Corneal Dystrophy

  A friend or relative has Fuchs’ Corneal Dystrophy

Please select ONLY ONE reason below that best tells  us why you want to join Fuchs’ Friends

 I am a doctor or corneal specialist.

 I want to learn more about Fuchs’ Corneal Dystrophy.

 I want to talk to someone else who has Fuchs’.

 I want to find a good Corneal Specialist in my area.

 I want to learn about ways to cope with Fuchs’.

 I want to hear about corneal transplant experiences.

 I want to discuss timetables and symptoms of Fuchs’.

 I want to discuss related eye problems such as cataracts glaucoma etc.

The Fuchs' Friends group at Yahoo is a private message board/email support group  for people with Fuchs' Corneal Dystrophy. 

You will be notified when our moderator approves your application.

If you have your email system set to block  emails from Yahoo.com or Yahoogroups.com, or set to manually ask for a response from the sender, you  will not receive the invitation from Yahoo.com, and we will not know that you  didn't receive the invitation. 

If you have told Yahoo to not send  invitations to you, Yahoo will not send you our invitation.  Please make sure  that you can receive the invitations sent by Yahoo.com.

More typographical errors are found in email addresses than any other field on this application. Please carefully reenter your email address  below:

An incorrect email address will cause your application  to be rejected

Please reenter your Email Address here exactly as you did earlier in this form

Please do not press the Submit button more than ONCE.  You might have to wait a few minutes until the server acknowledges that it received your request

Click Only ONCE

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