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Contact Registry

Step 1 of 5

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  • I agree and acknowledge that I am authorized to provide the following information about myself, my family, and the person(s) with KCNQ2 listed hereafter. I also understand and agree that the KCNQ2 Cure Alliance may contact me about the activities of the Alliance, provide information to me about KCNQ2 and future research studies and trials.
    Please carefully read the statement above. You must agree to the statement to be able to proceed with completing the contact registry.
  • Individual with KCNQ2 variant
  • MM slash DD slash YYYY
    This information is only used to calculate the person's age when sending out information in regards to research for a specific age group.
  • MM slash DD slash YYYY
    This information is only used to calculate the person's age when sending out information in regards to research for a specific age group.

Contact Us

(720) 772-1433

3700 Quebec Street Unit 100-118 Denver, CO 80207

info@kcnq2cure.org

About Us

The KCNQ2 Cure Alliance is a 501(c)3 non-profit organization (EIN #47-1810644). All donations are tax-deductible to the extent the law allows.

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