National Register of 503 Victims
Harm from biosolids is real. You are not alone.
Important Information for Getting Started - Read All:
Registration is simple and should take approximately 10 minutes to complete, but could take longer depending upon the level of detail provided in your responses. Please complete registration in one session. If you cannot, however, you may Save and Continue Later by clicking the Save button at the bottom of the page. You will receive an email with a link and instructions for completing your registration later. Do not click on Save unless you are exiting and plan to continue later. Registration is voluntary and limited to one submission per email/IP address. You must be 18 years or older to register. It is vitally important to the mission that the information being submitted is factual and true. Your registration is an important step towards achieving change. Thank you for registering. IMPORTANT: We recommend using a desktop computer for completing your registration. Although we do not anticipate any, should you experience technical issues while submitting your registration, SAVE or EXIT your form, then email a description of the problem to us at Connect@Mission503.org. Thank you.
Name
*
First Name
Last Name
Email
*
Confirmation Email
Please re-enter your email address
Are you registering on behalf of yourself only or for a multi-member household?
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Myself only
For my household
How many people does your registration represent?
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Important: Because you are registering for your household, please allow your responses to the remaining questions to encompass the members within your registration.
Select the primary U.S. State where your exposure to biosolids has occurred.
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Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
What is the primary postal ZIP Code where your exposure to biosolids has occurred? (5 digits)
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What is your connection to the biosolids ZIP Code? (Choose all that apply)
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Home
Commuting route
Work
Visit
School
Other
How long have you been exposed to biosolids?
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Round to the nearest whole year. For a household, enter the longest exposure among your members.
What is the primary form of biosolids disposal that you've been exposed to? (Choose all that apply)
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Land Application
Landfill
Lagoon
Incineration
Non-Agricultural Surface Disposal
Retail bag
Compost
Other
What is the shortest distance between the biosolids and your primary point of exposure?
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Less than 2 miles
Between 2-5 miles
More than 5 miles
What are your suspected pathways of exposure to biosolids? (Choose all that apply)
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Breathing
Drinking biosolids-tainted water
Eating biosolids-tainted food
Contact with contaminated surfaces
Bathing/showering in biosolids-tainted water
Skin absorption
Other
How have you been affected by exposure to biosolids? (Choose all that apply)
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Disruption to your life
Odors
Flies
Loss of use and enjoyment (home or property)
Loss of income
Loss of property value
Had to sell home to get away from biosolids
Had to temporarily leave home to get away from biosolids
Stress
Hardship
Acute illness
Chronic illness
Illness leading to death of a family member
Pet/Animal illness or death
Medical bills
Financial strain
Contamination (air, waters, soils, surfaces)
Contamination (crops)
Community unrest
Conflict with neighbors
Harassment/Intimidation
Threats
Loss of Freedoms
Other
Were you established in your ZIP Code before biosolids began getting disposed there?
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Yes
No
If you purchased your home in a biosolids ZIP Code, did you know, or was it disclosed to you before the purchase, that you were buying a home near biosolids disposal?
Yes
No
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Your Health While Exposed to Biosolids
IMPORTANT: It is well-known and universally-documented that exposure to pollutants such as pathogens, heavy metals, organic compounds, dioxin, forever chemicals, and other toxins can be harmful to human health. It is NOT well-known, however, that land-disposed biosolids create exposure pathways to these and other harmful pollutants. Please read through the health categories below and identify the illnesses you and your household have experienced during, or following, exposure to biosolids. This section is optional and not required for registration, but important for analysis and reporting. Only a few illnesses are listed per category to demonstrate and clarify the types of illnesses that comprise each health category. You may choose "Other", per category, to list additional diagnoses. You may also choose to not disclose any specifics within each category. VERY IMPORTANT: Providing truthful and factual responses in this self-reported data is vitally important to the integrity of our reports and the mission. Thank you.
Individual responses provided to the National Register of 503 Victims will not be disclosed in Mission503, Inc. Official Reports.
Responses will be consolidated and reported in aggregate.
Do you wish to continue with the health section, or skip it?
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Yes, I want to continue and contribute to the national data
I'd like to skip the health section
Diseases of the Respiratory System. Examples include, but are not limited to: (Choose all that apply, or skip to next category)
Yes, I/we have experienced respiratory illness but prefer to not disclose specifics
Sinusitis
Pneumonia
Bronchitis
Asthma
Allergic Rhinitis (allergies)
COPD
Collapsed lung
Hypersensitivity Pneumonitis
Respiratory disease leading to death
RADS
Other respiratory illness
Diseases of the Gastrointestinal System. Examples include, but are not limited to: (Choose all that apply, or skip to next category)
Yes, I/we have experienced gastrointestinal illness but prefer to not disclose specifics
Liver disease
Gastritis/Colitis
Gastroenteritis
Disorders of the stomach or esophagus
Intestinal or colorectal conditions
Gastrointestinal disease leading to death
Other gastrointestinal illness
Infectious & Parasitic Disease. Examples include, but are not limited to: (Choose all that apply, or skip to next category)
Yes, I/we have experienced infectious illness but prefer to not disclose specifics
Viral infections
Strep/staph
Parasitic infections
Septicemia
Salmonella
MRSA
E. coli
C. diff
Candidiasis
Adenovirus
Drug-resistant infections
Rotavirus
Intestinal infectious disease
Norovirus
Infectious/parasitic infections leading to death
Bacterial infections
Other infectious/parasitic illness
Diseases of the Skin & Subcutaneous Tissue. Examples include, but are not limited to: (Choose all that apply, or skip to next category)
Yes, I/we have experienced skin conditions but prefer to not disclose specifics
Skin ulcers
Skin infection
Eczema
Dermatitis/rashes
Chloracne
Hyperkeratosis
Inflammatory skin conditions
Other skin conditions
Endocrine, Metabolic & Nutritional Diseases, Immunity Disorders. Examples include, but are not limited to: (Choose all that apply, or skip to next category)
Yes, I/we have experienced endocrine, metabolic, nutritional or immunity conditions but prefer to not disclose specifics
Thyroid or adrenal disorders
Diabetes
High Cholesterol
Pancreatic disease
Autoimmune disorders
Nutritional deficiencies
Endocrine, metabolic, nutritional, immunity illness leading to death
Other endrocrine, metabolic, nutritional, immunity illness
Diseases of the Circulatory System. Examples include, but are not limited to: (Choose all that apply, or skip to next category)
Yes, I/we have experienced circulatory system illness but prefer to not disclose specifics
Heart disease
Ischemic heart disease
Hypertension
Disease of veins, arteries, capillaries
Heart disease & circulatory disease leading to death
Other heart disease & circulatory illness
Mental, Behavioral & Neurodevelopmental Disorders. Examples include, but are not limited to: (Choose all that apply, or skip to next category)
Yes, I/we have experienced mental or behavioral & neurodevelopmental illness but prefer to not disclose specifics
Depression/anxiety
Bipolar
Learning disabilities
Autism disorders
Mood/personality disorders
Schizophrenia
Psychosis
Mental, behavioral & neurodevelopmental disorders leading to death
Other mental, behavioral & neurodevelopmental disorders
Diseases of the Central Nervous System (CNS) & Sense Organs. Examples include, but are not limited to: (Choose all that apply, or skip to next category)
Yes, I/we have experienced CNS or sense organ illness but prefer to not disclose specifics
Conjunctivitis (Pink eye)
Eye & ear disorders
Seizures
Inflammatory disease of CNS
Migraine
Alzheimer's Disease
Dementias
Degenerative disease of CNS
Encephalitis
CNS & sense organ diseases leading to death
Other CNS & sense organ diseases
Diseases of the Genitourinary System (Urinary & Genital Tract). Examples include, but are not limited to: (Choose all that apply, or skip to next category)
Yes, I/we have experienced genitourinary conditions but prefer to not disclose specifics
Endometriosis
Kidney/renal disease
Infertility
Inflammatory pelvic disorders
Ovarian cysts
Bladder disease
Genitourinary disease leading to death
Other genitourinary system diseases
Cancer. Examples include, but are not limited to: (Choose all that apply, or skip to next category)
Yes, I/we have experienced cancer but prefer to not disclose specifics
Lung
Lymphatic
Breast
Bone
Leukemia
Pancreatic
Skin
Kidney
Cancer leading to death
Other cancer
Diseases of Musculoskeletal System and Connective Tissue. Examples include, but are not limited to: (Choose all that apply, or skip to next category)
Yes, I/we have experienced musculoskeletal or connective tissue conditions but prefer to not disclose specifics
Rheumatoid Arthritis
Disc disease
Bursa conditions
Curvature of the spine
Bone disease
Musculoskeletal and connective tissue conditions leading to death
Other musculoskeletal and connective tissue illness
Diseases of the Blood and Blood-Forming Organs. Examples include, but are not limited to: (Choose all that apply, or skip to next category)
Yes, I/we have experienced blood illness but prefer to not disclose specifics
Anemias
Blood disease
Blood & blood-forming disease leading to death
Other blood & blood-forming disease
Congenital Anomalies / Birth Defects: (Choose all that apply, or skip)
Yes, our family has experienced birth defects
Birth defects leading to death
Other, if you wish to list specifics
Other health issue(s) not categorized above. You may list here:
Thank you. You've completed the health categories. You're almost finished.
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Have you expressed concern to authorities about biosolids?
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No
Yes
How did authorities respond to your concerns? (Choose all that apply)
We were told they were following the law
We were told biosolids are safe and beneficial
They listened but nothing changed
We were ignored
Our concerns were marginalized
We began getting targeted
They listened to our concerns and stopped applying biosolids near us
Other
If you know the City/State or name of sanitation district that generates the biosolids that are disposed near your primary point of exposure, please provide here:
Name of City and State, or sanitation district
Is any member within your registration a farmer that currently uses biosolids, or has used them in the past, or farms on soils that have previously received biosolids?
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Yes
No
Does a member within your registration work with biosolids' transport or disposal?
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Yes
No
Now, just a couple final questions.
Using the email you provided today, may we send you future email with important Mission503 updates?
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Yes
No
May we contact you with questions regarding your registration, if needed?
*
Yes
No
Please provide the contact information you'd like us to use.
Name
First Name
Last Name
Mailing Address
Street Address or P.O. Box
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone Number
Please enter your most reliable phone number.
Email
example@example.com
Thank you! Please read carefully:
Before submitting your registration, you may use the BACK button located below to review or edit any of your responses. Do not select SAVE unless you plan to exit and complete your registration later.
After submitting your registration, you will receive a confirmation email that contains your registration ID. Please keep it for future reference.
Please tell us more about your biosolids experience on our 503 Victims' Stories portal, located on the Mission503.org website (found on Unite-Be Heard page). Please use the same email address to submit your story that you used for registering. Please also provide your registration ID.
Thank you for registering. Return to Mission503.org for more ways to get involved with our mission to end the land-disposal of biosolids.
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