Join the APF

Please complete the following form to join or renew your membership to the American Porphyria Foundation and help us in our mission to improve the health and well-being of all individuals and families impacted by Porphyria. Although APF membership is free, the suggested annual membership donation is $35 for members who live in the US and $45 for international members. We welcome any donation, but please remember that membership is complimentary. Together we can be a force for improved Porphyria healthcare. After you complete this form, please follow the instructions on the next page if you would like to contribute a suggested membership donation to the APF. If you choose not to donate, simply click the link at the bottom of the donation form to return to the website.

The American Porphyria Foundation relies on member support to sustain programs like research, newsletters, eNews, our website and other literature written or approved by Porphyria experts, our robust patient support programs, the Protect the Future program to train physicians how to properly diagnose and treat Porphyria, and our comprehensive patient and physician educational programs and services.

Contact Information

Name ∗

Address ∗

Birth Date

Phone ∗

Email ∗

Which of the following best describes you?

Healthcare professional

Porphyria patient

Family member

Other interested party
If other, specify:

Would you be interested in volunteering for porphyria medical research?

Yes

I'm already participating in research

Would you like to receive additional educational material regarding porphyria?

Yes

What information would you like to see on the American Porphyria Foundation website that is not already there?

Doctor's Information

Do You Have a Doctor Who Treats Your Porphyria?

Yes No

Please provide their contact information below:

Name

Doctor's Organization/Practice Name

Address

Phone

Do you have a doctor who does not treat your porphyria to whom you would like us to send information about porphyria?

Yes No

Name

Doctor's Organization/Practice Name

Address

Phone

Security and Privacy

Privacy reminder ∗

The American Porphyria Foundation is committed to maintaining the security of your information.

We will only collect information about you if you voluntarily provide it to us. We will use this information to better understand our members, and the data will only be shared with our advisors and APF members (with your permission). Your information, including your email address, will never be sold to any other third party organization under any circumstances without your consent unless required by law. You may remove yourself from this list at any time by contacting the APF.