test form page - The Speak Foundation

Before we connect you to a LGMD Center of Excellence care coordinator, we are also preparing our community for future clinical trials, and a key step is identifying individuals who may be interested and eligible.

Would you like to be contacted by the Speak Foundation for trials you may qualify for?*

Which best describes your current mobility?

Are you able to:

Stand from a seated position

Walk 10 meters

Climb stairs

N/A

Travel flexibility:

Yes

Yes, within my region

How far are you willing to travel?

Local only

Within my state

Within my country

Your age range:

0–6

6–12

12–18

18–24

25–34

35–44

45–54

55–64

65+

Would you like to join the LGMD Network to receive a free digital subscription of LGMD News Magazine along with relevant information related to research, events, and advocacy delivered to your email address?

Yes

Preferred Email

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