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Register and Benefit

To receive free information about your disease and research efforts to find treatments and cures, please fill out the form below. If you need assistance, please call FFB's toll-free information line at 800-683-5555.

 

1. Please fill out the information below:

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Name:

 

 

 

 

 

         

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City/State/ZIP:

 

    

 

 

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If you respond and have not already registered, you will receive periodic updates and communications from Foundation Fighting Blindness.

 

 

 

What's this?

*2.
Question - Required - Who is affected by a retinal degenerative disease?







*3.
Question - Required - Disease Diagnosis:









*4.
Question - Required - Please select the categories that you are interested in hearing more about:


*5.


 

We only collect personally identifiable information you provide in order to obtain our customized information and services. All of the information you provide us is treated as confidential by us.

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