Honor Your Hero

Whether you are a caregiver, friend, family member or patient, this May, GBS|CIDP Awareness month, we are asking that you send us your “Honor Your Hero” story to be shared with our community, and far beyond. Sharing your story is the most meaningful way to raise awareness, recognize your hero, and inspire GBS|CIDP patients around the world.

Your Information

First Name

Last Name

Email

Your Relationship to our Conditions

PatientCaregiver of PatientFamily or Friend of PatientMedical ProfessionalRelated Industry

Your Condition of Interest

Year Diagnosed

Your Hero's Information

First Name

Last Name

Email

Their Relationship to our Conditions

PatientCaregiver of PatientFamily or Friend of PatientMedical ProfessionalRelated Industry

Their Condition of Interest

Your relationship to your hero

Please describe why this individual is a hero to you in one paragraph:

Please upload a picture of your hero:

Would you like us to notify your hero about their nomination?

Street

City

State

Zip Code

Country

Please check this box to grant us permission to share this story and photo:

Contact ID

Contact Information