Networking Program
 

Written permission for NBIA's Networking Program

NBIA keeps names and addresses confidential unless a person (or parent) provides written permission for NBIA to send their name to other people (or families) affected by NBIA. This networking program is to offer insight, support and information to all those dealing with this rare disease.

If you wish to be put in contact with other people (or families) with NBIA, please complete the Networking Form. Please note that Adobe™ Acrobat Reader® is needed to view and print this form. It may be downloaded free of charge. NBIA will not add the names of third parties (i.e., teachers, social workers, etc.) to the NBIA Networking Program. Therefore, the patient or his/her immediate family must sign this form in order to participate in this program.