Apply to start a national association

Applicant — personal information

Name of applicant*

Date of birth

Gender

Female

Male

Non-binary

Prefer not to say

Self-describe

Address*

Street Address City ZIP / Postal Code Country

Phone*

Email address*

Your intent

I confirm*

I hereby express my wish to start a national IgG4-RD patient association in my country.

I request access to the toolkit support offered by the European IgG4-RD Patients Federation.

Associations are expected to pay a yearly fee. For associations with less than 10 members, the fee is currently 100 Euros. After the first year the fee may be indexed. For Associations with 10 or more members the fee is currently 250 Euros. After the first year the fee may be indexed. However, Associations joining in 2026 will not be charged their first year fee.

Diagnosis

Year of diagnosis

Diagnosing physician

Town / city

Conditions

Accept conditions*

I have read and accept the conditions of the Federation.

Additional patients

Are two or more additional patients willing to participate?*

Yes, two (or more) additional patients are willing to participate. I will provide their details below.

No, two other patients willing to assist have not yet been found.

Additional patient #1

Name*

Date of birth

Gender

Female

Male

Non-binary

Prefer not to say

Self-describe

Address*

Street Address City ZIP / Postal Code Country

Email*

Phone*

Year of diagnosis

Diagnosing physician

Additional patient #2

Name*

Date of birth

Gender

Female

Male

Non-binary

Prefer not to say

Self-describe

Address*

Street Address City ZIP / Postal Code Country

Email*

Phone*

Year of diagnosis

Diagnosing physician

Apply to start a national association

Application form

Applicant — personal information

Your intent

Diagnosis

Conditions

Additional patients

Additional patient #1

Additional patient #2