Fanconi Sign Up Information

Hi Jon,

I received your request to register for family services and education support with FARF, however your form was left incomplete and I'm unable to process your registration request without additional information. I'm sorry you even need to be registering with us at all, but I'm glad you've found us.

• What is your full name?
• Date of birth?
• What is your phone number and home address?
• Have you or a loved one been diagnosed with Fanconi anemia?
• When were you diagnosed?
• Do you have physical anomalies?
• Have you been through bone marrow transplant?
• If so, are you or your loved one seeing an FA specialist for this?
• If you have a child or loved one with FA, when were they diagnosed?
• Do you know which gene complementation group they belong to?
• Do they have physical anomalies or characteristics of FA? (e.g., short stature, malformed limbs or thumbs, skin discoloration, et.)
• Have they been through transplant?

I see that you've requested access to our private FB support group and unfortunately I'm unable to give you access to this until your registration is complete. This is in order to protect the privacy of our group members but also to know how we can best support you.

Please provide the information requested above in order to complete your registration and access the Facebook support group.

All the best,

Jordan

Jordan Deines, MSW, CSWA

Family Services Director

Fanconi Anemia Research Fund

1801 Willamette Street, Suite 200

Eugene, OR 97401

541.687.4658

www.fanconi.org