Change Form

First name: Name:           e-mail:

Country:          age:            Male or Female: Male Female

How are you involved in OI?: (mark any field that applies)
I have OI myself	I have a child with OI
My partner has OI	A family member has OI
I have a friend with OI	I am an OI scientist
I am interested in OI

I am a medical professional / healthcare worker, please specify:

None of the above but:

Your wishes/expectations:

Please help me to get in touch with other OI people near me       or those who might be helpful for my questions.       I allow you to share my data for that purpose.

I am a medical professional treating OI people       and I would like to get in contact with colleagues, please specify:

Comments:

We will treat your data absolutely confidential