Welcome to The Huddle
A safe space for men with IBD, The Huddle is a monthly zoom meetup hosted by Dr. Ugo and Marquis Ellison, a COCCI Ambassador with IBD. Zoom details will be provided in your registration confirmation.
Full Name:
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First Name
Last Name
Address: City & State
*
Email Address
*
example@example.com
What is your Ethnicity?
*
African American
Hispanic
Native American or Other Pacific Islander
Multi-Ethnic
American Indian
Asian
Caucasian
What is your age range?
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18-25
26-34
35-50
Other
Have you been diagnosed with Crohn's Disease or Ulcerative Colitis (IBD)?
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Crohn's Disease
Ulcerative Colitis
Neither
Do you know what a Chronic Illness Is?
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Yes
No
Do you know someone with Inflammatory Bowel Disease (IBD)?
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Yes
No
Does anyone in your immediate family suffer from IBD or any other chronic disease? (heart disease, cancer, diabetes, kidney disease, etc.)
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IBD (Crohn's or Ulcerative Colitis)
Heart Disease
Lupus
Cancer
Diabetes
Kidney Disease
Other
None
Multiple Chronic Diseases
Are you a current COCCI Member?
*
Yes
No
If no, would you like more information on becoming a member?
Yes
No
If you haven't already, would you like to subscribe to COCCI's monthly newsletters?
Yes
No
Join The Huddle
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