AFSED : Association Française des Syndromes Ehlers Danlos
NB : The mandatory fields are in red
Title: Not supplied Monsieur Madame Mademoiselle Docteur Professeur
Gender: Unspecified Man Woman
Name:
First name:
Is company? Do you manage a non profit organization, or a company? If you do so, check the box, and then enter its name in the field that will appear.
Company:
Nickname:
Birth date: (yyyy-mm-dd format)
Birthplace:
Profession:
Language: Français English Deutsch
Address: Address (continuation)
Zip Code:
City:
Country:
Phone:
Mobile phone:
E-Mail:
Be visible in the members list: If you check this box (and if you are up to date with your contributions), your full name, website address ad other informations will be publically visible on the members list.If you've uploaded a photo, it will be displayed on the trombinoscope page.Note that administrators can disabled public pages, this setting will have no effect in that case.
Username: (at least 2 characters)
Password: Please repeat in the field the password shown in the image.
Other informations:
Wheelchairs
Nbre de faut. roulants (man./élec.) (not translated)
Type de SED dominant (not translated) Select an option Indéterminé Aucun Hypermobile (type III) Classique (types I & II) Vasculaire (type IV) Cypho-scoliotique (type VI) Arthro-chalasique (type VII) Dermato-sparaxique type VII) Autre
Lettre d'informations électronique (not translated)
Journal du SED (version électronique) (not translated)
Journal du SED (version papier) (not translated)