Private Members 411
Personal and Private Information
The information you provide will be viewed within our private members page on our website only.
I agree to the following Private Members Agreement (Click All 3 Boxes):
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Personal Information Collection: All personal information collected in the members-only area of the CAD Foundation website is done so exclusively with your consent, by means of a form posted on our website or an email received from Cold Agglutinin Disease Foundation Inc via a direct link; email received from you or by phone. No information is collected automatically.
SHARING OF MEMBERS PERSONAL INFORMATION: Members will not, in any circumstances, share other members personal information with other individuals or organizations without the member's permission, including public organizations, corporations or individuals, except when applicable by law. By signing up and gaining access, members agree not to sell, communicate or divulge any members information to any mailing lists to solicit products, services, or advice. Cold Agglutinin Disease Foundation Inc. reserves the right to block users who violate or misuse these guidelines from our site and our pages.
Physicians Directory and Maps Disclaimer: Directories and Maps are intended for informational purposes only. Information submitted by the members of this webpage is considered true and accurate. Any use of the material provided is at the member's discretion and is his or her sole responsibility. Cold Agglutinin Disease Foundation Inc is not responsible for errors or omissions.
First and Last Name
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City
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Province/State
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Country
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Email
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Allow email to be viewed by other private members only.
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YES
NO
CAD Diagnosis
Please Select
Primary
Secondary
Newly Diagnosed
If you are diagnosed as CAD Secondary, what is the diagnosis
Doctor and Specialist Directory
Name, Address and Phone Number fields need to be completed in order to be added to the private member doctor/specialist directory. * We are only accepting 2 doctors/specialist at this time.
#1 Doctors/Specialists
Specialty (if any)
Street
City
State/Province
Country
Phone Number
Website
#2 Doctors/Specialists
Specialty (if any)
Street
City
State/Province
Country
Phone Number
Website
Submit
Should be Empty: