Zachary  
Supporting Aussie Kids with Kabuki Syndrome Inc.  
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WELCOME to SAKKS

Thank you for becoming a SAKKS member.

Your membership will help us to facilitate the SAKKS web site and forward to you all new information and Kabuki Syndrome discoveries.

In addition, all members will receive a copy of the SAKKS register bi-annually. This will assist you in making contact with other families, and sharing knowledge and experiences. If you don't wish to share your information, please ensure you check the box in the form below.

Membership Form

First Name(s):
Surname:
Street:
Suburb:
State:
Country:
Post Code:
Telephone Number:
Email Address:
 

Child's Name:

Birth Date:   Year:  
Gender:

Medical Problems:

Information you would like to share with others:

I allow my information to be shared*:
Add me to the SAKKS contact list:
I give permission for photos
of me/my child to be published
on the SAKKS site:

DISCLAIMER

I understand that access to the SAKKS contact list is for personal contacts only. Under no circumstances is the SAKKS contact list to be used for any other purpose, promotion of non-SAKKS activities, or marketing of any kind. By joining SAKKS you agree to respect the privacy of other members and their contact details.

Do you agree to these terms?
 

* By selecting 'Yes' you allow your information to be shared with medical professionals specialising in Kabuki Syndrome. The only information shared will be your location, your child's age, their medical problems, and the 'other information'
 
 
 
  
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