TSC Connect Registration Form

Name *

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Last *

Last

Email *

I would like to receive emails from TSC Alliance

Address *

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Date of Birth *

What's your primary connection to TSC? I am a... *

I am also a...

If you have TSC, what is your date of birth?

If your relationship is not listed above, please enter it here:

Is this your first contact with the TSC Alliance?

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By typing your name below you agree to the following: I agree to participate in the TSC Alliance TSC Connect program. I give permission to the TSC Alliance to release my name to other individuals and families affected by TSC. I will clearly communicate that I serve as a volunteer for the TSC Alliance and my opinions and comments reflect my personal experience in the diagnosis, testing, and treatments only and are not that of the TSC Alliance or medical professionals. Please type your full name.