Please use this form to confirmation your subscription request to the lissencephaly loop.

The loop is a closed list and we have a very strict privacy policy. Before approving you as a member, we may use the address and phone number to contact you to confirm your wish to join our group. This may seem a little outrageous just to join a mailing list, but it is the only way to ensure that the loop stays a “parents/family only” group. I hope that you will understand this and still wish to join our group.

All loop members are listed in the loop’s online directory (current under construction). Items 5 and 6 will be kept STRICTLY confidential unless you select “List address information in the Loop Directory”. If you choose No for this option, your address and phone number will not be listed. You will only be listed by your State and Country

* = Required Field

* 1. Your Name : *

2. E-mail Address:
(AOL members please remember to include @aol.com).

3. Your Yahoo ID (if you have one):
To approve your membership, we need to know what Yahoo ID you subscribed with. This may or may not be the same as your email address above.

* 4. Password :
(This will be used to access the loop member directory and is seperate from your yahoo password!)

Address Info :
Yes 
No 


Outside USA/CA, please select OTHER


Unlisted Country, please select OTHER

*

If your child or a child in your family has lissencephaly, please complete questions 7, 8 and 9, otherwise skip to item 9.


If Not listed, please select OTHER and enter below


If OTHER, please enter below

We like to announce each new member. We usually ask that each member of the loop introduce themselves to the loop. Some people take longer than others to adapt to the loop. If you have a short message you would like us to include in your announcement, please include it below. You may want to include your location (city/state). There are members from all over the world, so there may be someone on the list which is near by.


I am a current loop member completing the roll call   

There is a lot of medical information which is passed around on the loop. This is information from other parents on what may have worked for them. To try to protect the loop members and you from any legal action which may result from mis-use of the loop information, we ask that you read and agree to the following disclaimer statement. We cannot approve your request unless you agree to this disclaimer.

DISCLAIMER (Legal mumbo jumbo)

By accepting membership to the loop, you release all loop members from any
legal liability for advice given on the loop. You also agree that the loop is
not liabable for anything its individual members say or email they may send.
This advice should be used cautiously.  What may have worked from one
lissencephaly child may not work for your child.  CONSULT YOUR DOCTOR FIRST.

By accepting loop membership you also certify that you will not use any
information obtained from the loop for any type of medical research.  Your
personal experiences with the loop can be shared, but please remember to
obtain permission before mentioning any loop member by name/description.
The loop discussions are meant only to help other parents cope with raising
a child with lissencephaly.  Anyone breaking this "rule" will be immediately
and permanently banned from this mailing list.

I Agree 
I do not agree 

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>