What does autoinflammatory research mean to me?

Form made July 30, 2025

Basic info

Thanks for wanting to share your autoinflammatory story! This information is to help us to organize your stories in our system. It will not be made public, outside of what you say in your video, and agree to in your consent below.

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First Name *

Last Name *

Age *

Zip code-(Private) This helps us to organize stories by region. *

State, Country *

Email: For us to contact you only. It will not be shared publicly. *

Are you a patient, caregiver/family member, friend, advocate, or healthcare professional sharing this story? *

patient over 18 patient under 18 (have your parent do consent-both parts) parent/caregiver/guardian medical professional advocate friend

Optional: Please fill in the box with the autoinflammatory disease that you or your loved one has been diagnosed with by a healthcare provider. Examples: CAPS, FMF, HA20, TRAPS, MKD/HIDS, DIRA, SAVI, PRAAS/CANDLE, etc.. ("unclassified autoinflammatory disease", USAID, SURF or "autoinflammatory syndrome" is ok to list too.

Consent for the Autoinflammatory Alliance to use your story, video and images online, in print, video presentations or social media? Please see our policy at this link: https://docs.google.com/document/d/1QGJxQeyPhy1ab_OFPQstcmuzpbKGzjVG/edit?usp=sharing&ouid=113741598162186287160&rtpof=true&sd=true

yes with first and last name yes with first name yes with first name and initial for last name yes-anonymous-no name given yes-initials only no

Consent for minor under 18 years of age in a video. I, the parent consent for this video to be shared. Please enter your name, and your child's name. We will not share content without this signed for any minor. If you submitting for yourself, and 18 years of age or older, you can skip this question.

Date *

Upload your video: 1-1.5 min long max: What does autoinflammatory research mean to me, and why does it matter?

Upload your video: 1-1.5 min long max: What does autoinflammatory research mean to me? Please share your story, and why more research funding is needed.

Upload your video: 1-1.5 min long max: What does autoinflammatory research mean to me? Please share your story, and why more research funding is needed. *

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