Affiliates Groups One-Pager Information

Thank you for being such a vital part of our community. Your contributions are greatly appreciated.

We would be honored if you would take a few minutes to complete the following form. The information you provide will be used to create a one-page document that highlights your organizaton and the resoruces you offer.

Thank you in advance for your time
Organization Name
Organization Email
example@example.com
Web Address
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Group Your Organization Represents
Who you are / Serve

0/45
Organization Vision

0/45
Organization Mission

0/45
How your organization IMPACTS patients

0/60
Your Organization Story

0/260
How you provide support at a glance

0/50
Upload your Logo Here

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Upload up to 2 images of individuals affected by your skin condition.

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Would you like to include a QR Code on your One Pager?

Yes, I will upload one our organization has.Yes, I need one created for our organizationNo
Upload QR Code

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Provide a link, for QR Codes to be added to your one-pager
Enter Your Social Media Handles
Should be Empty: