Contact Information

Country
State / Province*
Address
City
Email*
Confirm Email*
Phone
What is your connection to Angelman Syndrome?*
  • Parent
  • Caregiver
  • Family Member
  • Doctor, Therapist or Other Professional
  • Friend
  • Donor
  • Other

Child Information

If Parent, please provide additional information about your child

Name
Birth Date
Genotype
  • Deletion
  • UBE3A Mutation
  • Uniparental Disomy (UPD)
  • Imprinting Center Defect (ICD)
  • Clinical Diagnosis
  • Unknown
Additional Comments

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