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• 2: MPS Diseases
• 3: Fabry Disease
• 4: Advocacy Support
• 6: Fundraising
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• 8: Research
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• 22: MPS House
• 27: CRB Checks
• 28: Links
• 29: Site Map
• 30: Terms and Conditions

Under the Data Protection Act 1998 the Society for Mucopolysaccharide Diseases is committed to safeguarding the privacy of our members and users while providing a personalised and valuable service. The Society is registered with the Data Protection Commission and adheres to the principles laid down under the Data Protection Act in processing personal data. If, after reading this Data Protection and Personal Privacy Statement you choose to submit personal data, for example, by registering an MPS sufferer, it is deemed that you are thereby giving your consent for that data to be held and processed in accordance with this statement. The data you provide us with will be held securely to enable us to provide support and information in accordance with our aims and objectives. No personal data will be shared with a third party. 

If you have any requests regarding your personal information please contact the Society by post, phone or email.

First Name of Affected*

Surname of Affected*

Child / Adult*

Addressee (if different)

House / Number / Road*

Address line two

Town*

County / State*

Postcode / Zip Code*

Country*

Phone

E-mail*

Please tell us if you are* Select OneAn individual with MPSA parent of an MPS individualAnother relative of an MPS individualA professional interested in MPSOther (please state)

If 'other' state here

Disease Type* Select oneScheie Disease (MPS IS)Hurler Disease ( MPS IH)Hurler Scheie Disease (MPS IHS)Hunter Disease (MPS II)Sanfilippo Disease Type A (MPS IIIA)Sanfilippo Disease Type B (MPS IIIB)Sanfilippo Disease Type C (MPS IIIC)Sanfilippo Disease Type D (MPS IIID)Morquio Disease Type A (MPS IVA)Gangliosidosis GM-1 (MPS IVB)Maroteaux Lamy Disease (MPS VI)Sly Disease (MPS VII)Hyaluronoglucosamindase 1 (MPS IX)SialidosisI-Cell Disease (ML II)Pseudo-Hurler Polydystrophy (ML III)ML IVMannosidosis AlphaMannosidosis BetaFucosidosisAspartylglycosaminuria (AGU)Multiple Sulphatase Deficiency (MSD)Gangliosidosis GM-1Gangliosidosis GM-2Fabry DiseaseNatowicz (MPS IX)Neuramidase Deficiency (ML I)Geleo Physic DysplasiaSialic Acid DiseaseWinchester

Date of Diagnosis*12345678910111213141516171819202122232425262728293031 JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010

Date of birth12345678910111213141516171819202122232425262728293031 JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 1910191119121913191419151916191719181919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018

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