Lifetime Membership Registration

Your foundation for support

The Smith-Lemli-Opitz Foundation network is here to support you as you navigate your journey with SLOS.

Be in the know

Be notified with new information about SLOs and its treatments.

Connect with others

Those who know what you are going through will provide valuable support.

Improve your quality of life

Lifetime membership to resources and relationships to improve your life with SLOs.

Membership Registration

Upon submitting your registration information, you will receive a response via email from the Smith-Lemli-Opitz Foundation approving your membership. You will receive an annual email to confirm your information and lifetime registration.

Name *

First

Last

Previous Name, if applicable

First

Last

Facebook Name, if different

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email *

Email (alternate)

Home Phone *

Cell Phone *

Cell Phone (alternate)

Occupation

Primary Language Spoken at Home *

Number of Children with SLOS *

Tell us a little bit about about your family or your connection and interest in SLOS.

Upload photos (optional)

Click or drag files to this area to upload. You can upload up to 3 files.

Would you like to volunteer for the Smith Lemli Opitz Foundation? *

Would you like to volunteer for future conferences? *

Would you like to volunteer for hosting a fundraiser? *

If you are new to SLO, would you like another family mentor to contact you? *

Yes
No
Not applicable

If you are not new to SLO, would you be willing to mentor another SLOS family located in your area? *

Yes
No
Not applicable

Are you interested in having your child or adult child with SLOS participate in a SLOS research study? *

Yes
No
Not applicable

Permissions & Requests

Permission to share information with other families *

I give my permission to have my name, address, phone number, or email information shared with other registered SLOS families.
I DO NOT want my name, address, phone number, or email information shared with other registered SLOS families.

Request for more information • sharing of contact information *

I am interested in learning more about the SLOS natural history study at the NIH. I give permission to the SLO Foundation to share my contact information (name, address, phone, and email) with the study's principal investigator so I can learn more.
At this time, I am not interested in more information and do not wish to share my contact information with medical or pharmaceutical professionals.

Unsubscribe

Please remove me from your mailing list.

Date / Time

Date

Time

Who We Are

Our Mission

Contact Us

Living with SLOS

Support Resources

Education Resources

Research Studies

SLOS RESEARCH

Ways to Give

Fundraise

Volunteer

Advocate

Who We Are

Our Mission

Contact Us

Living with SLOS

Support Resources

Education Resources

Research Studies

SLOS RESEARCH

Ways to Give

Fundraise

Volunteer

Advocate

Your foundation for support