Registration Form

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Email: *
Date of Birth:
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Purpose of enquiry:
I am a consumer requesting information for myself
I am a health professional requesting information for a patient/client (please complete the information below about the specific condition)
I am a health professional/organisation requesting a display pack to show my patients/clients/members. Please ensure that you provide the organisation’s/company’s name and your position details in the registration form above.
If you would like specific information, email
Do You Have a Specific Condition:
Ankylosing Spondylitis Gout Psoriatic
Fibromyalgia Rheumatoid Arthritis Lupus
Osteopaenia Osteoporosis Scleroderma
Osteoarthritis Osteoarthritis of the knee
JIA: 0 - 10 years JIA: Teenagers - young adults
Other, please give details
Age Group:
0-24 25-34 35-44 45-54 55-64 65+
Where did you hear about Arthritis WA:
Family/Friend Health Professional Newspaper
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