• Wound Healing Conference Participation Interest

  • The National Foundation for Ectodermal Dysplasias (NFED) is pleased to invite individuals and families affected by TP63-related disorders (including AEC, EEC, ADULT, and limb-mammary syndromes) to our upcoming Wound Healing Conference, taking place from Thursday, September 24 to Saturday, September 26, 2026, in Chicago, Illinois. This conference will bring together patients, caregivers, researchers, and clinical experts to collaborate, share experiences, and advance critical research. Because space is limited, please complete this interest form to help us plan and finalize attendees. We hope you will join us for this meaningful event!

  • Primary Contact Information

  • Format: (000) 000-0000.
  • Relationship to Affected Individual(s) (check all that apply)*

  • Attendance & Logistics

  • Are you interested in attending the 2026 Wound Healing Conference in Chicago, Illinois?*

  • Estimated Travel Dates:

  • Arrival Date*
     / /
  • Departure Date*
     / /

  • Attendee Details & Demographics

    • Attendee #1 
    • Affected by Ectodermal Dysplasia?*
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    • Date of Birth*
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    • Ethnicity*
    • Pronouns*
    • Dietary Restrictions (check all that apply)*
    • Attendee #2 
    • Affected by Ectodermal Dysplasia?*
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    • Date of Birth*
       / /
    • Ethnicity*
    • Pronouns*
    • Dietary Restrictions (Check all that apply)*
    • Attendee #3 
    • Affected by Ectodermal Dysplasia?*
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    • Date of Birth*
       / /
    • Ethnicity*
    • Pronouns*
    • Dietary Restrictions (Check all that apply)*
    • Attendee #4 
    • Affected by Ectodermal Dysplasia?*
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    • Date of Birth*
       / /
    • Ethnicity*
    • Pronouns*
    • Dietary Restrictions (Check all that apply)*
    • Attendee #5 
    • Affected by Ectodermal Dysplasia?*
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    • Date of Birth*
       / /
    • Ethnicity*
    • Pronouns*
    • Dietary Restrictions (Check all that apply)*
    •  

    • Questions/Comments

    • Participation Consents

    • I consent to the National Foundation for Ectodermal Dysplasias (NFED) using photographs and video recordings of me and/or my family and hereby irrevocably grant the NFED the perpetual right to use my name and likeness as incorporated in any such photographs or video recordings. I agree that the NFED shall own all rights, title and interest to such photographs and video recordings, and that the NFED may edit, modify, and distribute such photographs without limitation, and without compensation, further permission or notification from me. I hereby waive any inspection or approval of use. I also waive and release the NFED from any claims based upon invasion of privacy or right of publicity.*

    • Thank you for your interest and willingness to participate in this study. By signing this form, you are expressing your interest in taking part, but participation cannot be guaranteed, as enrollment will depend on the number of families needed for the study and study eligibility.

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