MDI Adult's Membership Form
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Applying for membership
Membership Type
Person with muscular dystrophy age 18 or over
Individual family member of person with muscular dystrophy
Volunteer age 18 or over who works with persons with muscular dystrophy
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
Street
Town/Area
City/County
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Co Antrim
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Co Down
Co Dublin
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Dublin 10
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Dublin 16
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Dublin 18
Dublin 2
Dublin 20
Dublin 22
Dublin 24
Dublin 3
Dublin 4
Dublin 5
Dublin 6
Dublin 6W
Dublin 7
Dublin 8
Dublin 9
Co Fermanagh
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Co Tipperary
Co Tyrone
Co Waterford
Co Westmeath
Co Wexford
Co Wicklow
International
Country
Postal Code
Phone
Mobile Phone
Email
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
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None
Unknown
Adult spinal muscular atrophy
Autoimmune myositis
Becker muscular dystrophy
Bethlem myopathy
Central core myopathy
Congenital fibre-type disproportion myopathy
Congenital muscular dystrophy General
Congenital myasthenic syndromes
Congenital myotonic dystrophy, Myotonia
Duchenne muscular dystrophy
Emery-Dreifuss muscular dystrophy
Facioscapulohumeral muscular dystrophy
Friedreich’s ataxia
Hereditary motor and sensory neuropathies (Also known as Charcot-Marie-Tooth or peroneal muscular atrophy)
Inclusion body myositis
Juvenile dermatomyositis
LGMD 1B (also known as laminopathy)
LGMD 1C (also known as caveolinopathy)
LGMD 2A (also known as calpainopathy)
LGMD 2B (also known as Dysferlinopathy)
LGMD 2I
Limb-girdle types of muscular dystrophy (LGMD) General
Manifesting carrier of Duchenne
McArdle’s disease
MDC1A (merosin-deficient congenital muscular dystrophy)
Metabolic disorders General
Minicore (multicore) myopathy
Mitrochondrial myopathies
Myasthenia gravis
Myopathy
Myositis
Myotonic dystrophy
Myotubular or centronuclear myopathy
Nemaline myopathy
Neuropathy
Ocular myopathies including ocularopharangeal muscular dystrophy
Periodic paralyses
Polymyositis, dermatomyositis and sarcoid myopathy
Pompe’s disease
Rigid spine syndrome (RSS)
Spinal muscular atrophies Intermediate (Type II)
Spinal muscular atrophies Mild (Type III)
Spinal muscular atrophies Severe (Type I)
Ullrich congenital muscular dystrophies
Other
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