MDI Adult's Membership Form
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Applying for membership
Membership Type
Person with
Muscular dystrophy and related neuromuscular conditions
age 18 or over
Individual family member of person with muscular dystrophy
Volunteer age 18 or over who works with persons with muscular dystrophy
What description fits you best as a family member?
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Parent
Husband
Wife
Partner
Grandparent
Sibling
Aunt
Uncle
Friend
Annual membership runs from January to December.
All new membership applications will need to be approved by the Board.
How did you hear of MDI?
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Clinic Liaison Officer
Social Media
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Word of Mouth
MDI Staff Member
Medical Professional
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Other
General Details
First Name
Last Name
Gender
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Male
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Prefer Not To Say
Street
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Co Westmeath
Co Wexford
Co Wicklow
International
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Postal Code
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Birthdate
If you have muscular dystrophy / a neuromuscular condition, please select the name of the condition from the dropdown menu in the box below so that we can maintain accurate information and tailor our services to your condition.
Type of Muscular Dystrophy
Please select...
Atypical neuroaxonal dystrophy
Duchenne muscular dystrophy
Amyloidosis
Atypical neuroaxonal dystrophy
Becker muscular dystrophy
Hypokalenic Periodic Paralysys
Charcot-Marie-Tooth (Hereditary motor and sensory neuropathies or peroneal muscular atrophy)
Condition Unknown by MDI
Condition Unknown by mem
Congenital Muscular Dystrophy
Duchenne muscular dystrophy
Emery-Dreifuss muscular dystrophy
Facioscapulohumeral muscular dystrophy
Friedreich’s ataxia
Fukuyama Muscular Dystrophy
Gitelman's Syndrome
hATTR Amyloidisis
Laminopathy type 1A
LEMS (Lambert-Eaton Myasthenic Syndrome)
Limb-girdle types of muscular dystrophy (LGMD)
Lower Limb Segmental Amyotrophy
Manifesting carrier of Becker or Duchenne
McArdle’s disease
Metabolic disorders General
Mitrochondrial myopathies
Muscular Atrophy
Myasthenia gravis
Myositis
Myopathies
Neuropathy
None
Other
Spinal Muscular Atrophies
Neurogenic Anthrogryposis multiplex congenita (AMC)
Periodic paralyses
Riboflavin transporter Deficiency
Sodium channel myotonia
Type of Muscular Dystrophy (Continued)
Please select...
N/A
CMT Axonal type 2GG
CMT Type 1
CMT Type 1B
CMT Type 1x
CMT Type 4
Hereditary motor and sensory neuropathies (Also known as Charcot-Marie-Tooth or peroneal muscular atrophy)
Hereditary Neuropathy with Liability to Pressure Palsies (HNPP)
Bethlem myopathy
Congenital muscular dystrophy General
Merosin-deficient congenital MD
Nemaline Myopathy
Ullrich congenital muscular dystrophies
Limb-girdle types of muscular dystrophy (LGMD) General
LGMD 1B
LGMD 1C
LGMD 2A
LGMD 2B
LGMD 2I
Peripheral Muscular Atrophy
Autoimmune myositis
Dermatomyositis
Inclusion body myositis
Juvenile dermatomyositis
Myositis
Polymyositis
Congenital myotonic dystrophy
Congenital Titinopathy
Central core myopathy
Congenital fibre-type disproportion myopathy
Desmin Myopathy
Dystal Myopathy
GNE Myopathy
Minicore (multicore) myopathy
MMF MD Macrophagic Myofaciitis
Myotonic dystrophy
Myotubular or centronuclear myopathy
Nemaline myopathy
Polymyositis
Protein Aggregate Myopathy (unspecified)
Polymyositis
Amyloid Neuropath
Anti- mag peripheral neuropathy
CIDP Neuropathy
Neuropathic sarcoidroitis
Hereditary Neuropathy with Liability to Pressure Palsies (HNPP)
Hereditary Neuropathy
Neuropathy
Idiopathic Neuropathy
Sorbitol Dehydrogenase Deficiency (HMSN Group)
Riboflavin
SMA-LED
Spinal muscular atrophies Intermediate (Type II)
Spinal muscular atrophies Mild (Type III)
Spinal muscular atrophies Severe (Type I)
Spinal Bulbar Muscular Atrophy (SBMA) or Kennedy’s Disease and X-linked SBMA
Spinal muscular atrophy (Type IV)
Spinal Muscular Atrophy with Respiratory Distress (SMARD1)
Please select a more specific type if applicable.
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