Download the PDF file for printing on your computer printer, CLICK HERE
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If you choose to submit your registration by
mail, using this pdf form, to insure complete accuracy,
please write your initials, zip code, and today's date on all pages, and
fill in circles completely
The following questions must be answered in order for your information to be included in the database:
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First and Last Name
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Street Address
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City, State and Zip code
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Question #1: Are you willing to participate in a national study to find the genes that might put someone at risk for developing COPD?
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Question #2: Are you willing to have the information in this questionnaire stored in a confidential database at the COPD Foundation and at the National Jewish Medical and Research Center ?
If you have questions or
need more information,
Please call the toll free
COPD Foundation's
COPD Information Line.
(866) 316-COPD (2673)
Please print envelope address as follows:.
| (Your Return Address) |
The COPD Foundation Survey c/o National Jewish Medical and Research Center 1400 Jackson Street, K707 Denver, CO 80206 |
Postage |
|
ATTN:
Christina Wheeler, BA, CCRC Coordinator |
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