DOH - form test - Cystinosis Research Foundation

Skip to content

Which event are you registering for?*
- Children's Program
Name*
First Last
Email*
Does the email address provided have a zoom account (required for breakout sessions):
- Yes
- No
Since you don't have a Zoom account, please sign up here prior to the event: https://zoom.us/freesignup/
Cell Phone # (optional)
Address (optional)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
What is your connection to cystinosis?*
- I have cystinosis
- My child has cystinosis
- My partner or spouse has cystinosis
- My grandchild has cystinosis
- My extended family member has cystinosis
- My friend or friend's child has cystinosis
- Physician
- Researcher
- Pharmaceutical industry
What is your age?*
- I am an adult 18 years or older
- I am a teenager
- I am a 12 years old or younger
What is your child’s name? Please list first and last*
First Last
How old is your child?*
Would you like to register another child?
- Yes
- No
What is your child’s name? Please list first and last
First Last
How old is your child?
What is the name of your partner or spouse? Please list first and last*
First Last
What is your grandchild’s name? Please list first and last*
First Last
How old is the child?*
Optional - What is the family member’s name?
First Last
Optional - How old is the family member?
Optional - What is the friend's name?
First Last
Optional - How old is the individual with cystinosis?
Where are you located? Please list city, state, country*
What is your specialty?*
Are you currently seeing cystinosis patients?*
- Yes
- No
Where are you located? Please list institution name, city, state and country*
Have you ever been funded by CRF? If so, list approximate date and institution name*
What is the name of your company and where is it located? Please list city, state, country*
Family Breakout Sessions - Which would you like to attend?*
- Parents of Little Ones (0–5 yrs) - Hosted by Joshua “JJ” Zaritsky, MD, PhD Moderated by Jill Emerson
- Parents of Kids (6–12 yrs) - Hosted by Julian Midgley, BM, BCh (MD) Moderated by Stephen Jenkins, MD
- Teens (13 and up, not for parents) – Hosted by Paul C. Grimm, MD Moderated by Lauren Hartz
- Parents of Teens – Hosted and Moderated by Brian Sturgis
Email address attending this breakout session:
Does the email address provided have a zoom account (required for breakout sessions):
- Yes
- No
Since you don't have a Zoom account, please sign up here prior to the event: https://zoom.us/freesignup/
As a parent would you like to attend the Parents of Teens session or another session? (Requires a separate computer or smart phone to join the Zoom meeting)
- Yes
- No
Which breakout session would you like to attend?
Email address attending this breakout session:
Does the email address provided have a zoom account (required for breakout sessions):
- Yes
- No
Since you don't have a Zoom account, please sign up here prior to the event: https://zoom.us/freesignup/
The session you selected is for Parents of Teens. Would your teen like to attend the Teens session also?
- Yes
- No
Email address attending this breakout session:
Does the email address provided have a zoom account (required for breakout sessions):
- Yes
- No
Since you don't have a Zoom account, please sign up here prior to the event: https://zoom.us/freesignup/
Would you like to receive the electronic Cystinosis Research Foundation monthly Star Facts newsletter?*
- Yes, please add my email to the distribution list
- I’m already part of the CRF fan club!
- No thank you, not at this time
How did you find out about this webinar?*
- Email from CRF
- CRF website post
- Facebook Post
- Friend of Family Member

120x60

GreyContent Credit Card Safe White Sqr 1

Who We Are

What is Cystinosis
About CRF
Leadership
Financials
Videos
Cystinosis Magazine
CRF News
Contact CRF

For Families

Family Stories
Canadian Families
Current Clinical Trials
Cure Cystinosis International Registry (CCIR)
Tools for Fundraising
Resources

For Researchers

Research Overview
Grants Awarded
Apply for Research Grant
Published Studies
International Cystinosis Research Symposium

Events

Natalie's Wish
Day of Hope

Cystinosis Research Foundation

19200 Von Karman Avenue
Suite 920
Irvine, CA 92612

(949) 223-7610

info@cystinosisresearch.org

Subscribe to our Star Facts E-Newsletter

© 2025 Cystinosis Research Foundation. All Rights Reserved

Privacy Policy | Accessibility Statement
Designed by Idea Hall

Facebook-f Youtube Instagram

Who We Are

What is Cystinosis?
About CRF
Leadership
Impact of CRF Research
Financials
Videos
Cystinosis Magazine
CRF News
Contact

For Families

Family Stories
Canadian Families
Current Clinical Trials
Cure Cystinosis International Registry (CCIR)
Tools for Fundraising
Resources

For Researchers

Research Overview
Apply for Research Grant
Grants Awarded
Published Studies
International Cystinosis Research Symposium

Events

Natalie's Wish
Day of Hope

Together We Shine Bright

(949) 223-7610
info@cystinosisresearch.org

(949) 223-7610
info@cystinosisresearch.org