General registration for further information

Title:
First name*:
Surname*:
Street / number*:
Country*:
Postal code*:
Town*:
Phone:
Fax:
E-mail*:
I support the interests of this International Patient Information Board on TBE/FSME. I would like to be informed about new activities and projects of this group via e-mail. I would like to actively support a patient advocacy group in my country. I would like an expert to get back to me with an answer to the following question
General feedback on this patient platform, ideas for new content, ...
* I agree to my personal data (including my questions) being provided to the expert(s) and/or representative(s) of the support group and to my personal data being saved in anonymous format for further statistical evaluation. I may revoke my declaration of consent for the future at any time.
Please note that information sent by email is at a risk of loss of confidentiality when transmitted over the Internet.
* Mandatory entry

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