Please note this form is for somebody with a confirmed diagnosis of Motor Neurone Disease. If you are registering on another person’s behalf, please ensure you have discussed this with them, and they have given consent for you to share their details with us.
The person must be a resident of the Republic of Ireland. If you experience any difficulties completing this form, please call the office on 01 670 5942. Thank you.
We will only contact you when relevant. Please let us know how you wish to receive contact from us.
Nominated Contact Details
Does your nominated contact person wish to receive communications from the IMNDA?