AIU Mailing List

AIU Mailing List

First/Last name, Email and State are required. All other information is optional.
In the past AIU has used MailChimp for our online mailing list. We are transitioning to a new service that is free for non-profits called GiveButter.

By giving AIU your name and email you are consenting to receive emails from Adrenal Insufficiency United Board Members and Director. Your contact information will not be shared with any other business or entity without your expressed permission.

We encourage you to fill out as much information as possible as it helps AIU as we seek out partners, grants, and research opportunities.

If you live outside the USA you can still sign up for our mailing list. The phone number input will not work, but it's not required so just skip that.
Name*

First NameLast Name
Primary Email*

Confirmation Emailexample@example.com
Additional emails separated with a comma
Phone Number (Cell)
Please enter a valid phone number.
May we send text messages to this phone

YesNo
Alternate Number: home or cell
Please enter a valid phone number.
May we send text messages to this phone

YesNo
Mailing Address Line 1
Address Line 2
City
State/Province *
Zip
Country
Who are you?

An adult age 18 or older with Adrenal InsufficiencyThe parent/caregiver of a child under the age of 18 who has adrenal insufficiencyThe parent of an adult 18 or older who has adrenal insufficiencyThe parent/caregiver of an affected adult over 18 who is unable to care for themselvesAn unaffected friend or family memberA health care providerBoth a parent/guardian with adrenal insufficiency and an affected adult with adrenal insufficiencyOther
Birthdate of affected ADULT over 18 (only fill this out if you are the affected adult or the parent/caregiver of an affected adult unable to fill out this form)

MonthDayYear
Date
Birthdate of affected CHILD under 18 (only fill this out if you are the parent/caregiver of the affected child)

MonthDayYear
Date
Birthdates of any other affected children in your household. Please separate each birthday with a comma. 1/12/2021, 4/4/2012 etc.
A question/request for:
- For Affected Adults
- Parents of children under 18
- Parents/Caregivers of Adults unable to fill out forms on their own
Many grants ask AIU information that we do NOT typically ask of our members. As we grow in our membership our needs for funding to serve you all increase and we are planning to seek out grant opportunities in the future.

If you are willing to provide more personalized information we can use in our grant writing and/or communications with companies interested in sponsoring us please opt in below. We will email you the additional survey in February.

AIU does not share emails or contact information. We will never share information that can identify you. Anything used in this or other surveys will be de-identified.
I am willing to fill out additional surveys, you may email me the link.

YesNot at this time
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