The Arthrogryposis Group

Your information
* required fields
First Name *		Address 1 *
Last Name *		Address 2
Email *		Address 3
Re-type email *		City *
Date of Birth *		County *
Phone Number *		Post Code *

Please create a username. The following characters are not allowed in the username: ' ; / \ : ( ) % < > -
username * check username
Retype username *
Please create a password. The following characters are not allowed in the password: ' ; / \ : ( ) % < > -
password *
Retype password *

Are you a clinical practitioner? Would you like to join the password protected practitioners discussion (this is not automatic and is at the discretion of TAG.

Relationship to person with arthrogryposis *
Details of the person with arthrogryposis
Name of person with arthrogryposis *
Date of birth of person with arthrogryposis *
Please give any specific diagnosis e.g. Amyoplasia, Distal Type, Pterygium etc.
A description of disabilities and medical history would also be helpful
Please tick which you think best describes the care requirements of the person with arthrogryposis Pretty good, does not or will not need much help Needs some or might need some help and assistance Does need or will need constant help and assistance throughout life
Please give the name of any clinic and/or hospital you/they may attend:
Additional Family Details
If the person with arthrogryposis is under 16 years of age please give the names and dates of birth of any brothers and sisters
The Arthrogryposis Group (TAG) will only use your personal information to provide you with information, services or products you have requested, for administration purposes and to further our charitable aims. By completing this form you are giving permission to share the information contained within it with others involved with TAG. If you do not wish to share your information with others in TAG please tick this box
Please read the taguk.org.uk registration agreement before submitting this form. Then if you are happy to proceed tick this box:

Your information

Details of the person with arthrogryposis

Additional Family Details