Thank you for your interest in joining the registry. To begin enrollment, please click the link below.
Participating in the registry is voluntary and there is no cost to enroll. This Pre-enrollment Questionnaire includes questions about the participant’s demographic information, military service (if applicable), and exposure to contaminated water, as well as contact information for the person completing the form. The questionnaire will take about 10 minutes or less to complete for each person.
A separate questionnaire is required for each person you plan to enroll as a participant in the registry and all adults should complete their own enrollment. Questionnaires cannot be completed on behalf of an entire family.
This questionnaire may be completed for yourself, or on behalf of your child or another adult for whom you are the legally authorized representative. Please ensure that only one parent/guardian fills out a questionnaire for child or adult for whom they are a legally authorized representative to ensure no duplicate entries on behalf of that person.
After submitting the complete pre-enrollment, you may be sent one of two Enrollment Questionnaires for each person, depending on the timing and location of the participant’s exposure. These questionnaires will require additional consent prior to completion.
If you have questions at any time, please contact registry staff by phone at 808-427-8260 or by email at [email protected].
