Registry – OPMD Association

Community Registry

Welcome to the OPMD Association Community Registry. The purpose of the registry is to communicate research initiatives and information to OPMD Community members. Participation in the Registry is your opportunity to advocate for OPMD research.

Registry Application

Your participation in the OPMD Association Community Registry is voluntary. To participate, fill out the following form. Should we become aware of a research opportunity, we will email you with the information that you will need to contact the research entity directly. We will not contact the research organization on your behalf.

The OPMD Association does not share or sell your personal information. Please refer to the OPMD Association’s Privacy Policy.

If you discover an OPMD research study, please share with us, Contact Us

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Personal Information

Name*

First Middle Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email Address*

OPMD Association Newsletter

Subscribe to the OPMD Newsletter

Phone Number*

Declaration & Acknowledgement

The OPMD Association’s OPMD Community Registry exists for the sole purpose of communicating information to the OPMD Community regarding participation in potential research initiatives. The OPMD Association does not share or sell your personal information.

Your participation in the OPMD Community Registry is voluntary. Should we become aware of a research opportunity, we will email you at the email address you provided. Note that you will be required to contact the research entity directly. We will not contact them on your behalf.

I acknowledge that I have read, understand, and agree to the purpose of the OPMD Community Registry. I acknowledge that any or all the content submitted to the OPMD Community Registry will be kept private and will only be used to contact me. Should I require additional information regarding the OPMD Association’s Privacy Policy, I will refer to the Association’s website.

Signature (Type Name)*

Full Legal Name*

Date*

This field is for validation purposes and should be left unchanged.

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