Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone Number * (###) ### #### Role Patient Patient Family VCU Staff Vendor/ Patient Foundation Speaker Attendance In Person Virtually Additional guests attending? Yes No Attending guest name Which neuromuscular disease(s) are you interested in learning more about (select all that apply): DM/CDM FSHD LGMD DMD Becker MD SMA Lunch will be provided. Please let us know of any dietary restrictions. Vegan Vegetarian Halal Kosher Gluten free Allergy Other Allergy or Other Dietary Restrictions Thank you for registering for Patient Education Day!We'll be in touch regarding your registration a member of our team will email you prior to the event. 2025 Patient Education Day Registration
