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GBS/CIDP Foundation International
The Holly Building
104 1/2 Forrest Avenue
Narberth, PA 19072
Voice: 610-667-0131 - Fax: 610-667-7036
Email: info@gbs-cidp.org

Changing your registry information allows us to inform you of new updates on GBS/CIDP. This will also help to keep our mailing costs down from returned mailings.

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OLD INFORMATION
First Name: 
   
Last Name: 
   
Street  Address: 
   
   (Apt, Unit, etc.)
City: 
   
State or  Province: 
 
If not listed above, please enter below:  
 
Country: 
 
If not listed above, please enter below:  
 
Zip or Postal Code: 
   
Phone  Numbers: 
Country Code ("1" for US and Canada)
Area Code or Intl City Code (if reqd.)
Your Local Number
Phone: 
  - -  
E-mail: 
 
Please Change or add the following information to my registry.
First Name: 
   
Last Name: 
   
Street  Address: 
   
   (Apt, Unit, etc.)
City: 
   
State or  Province: 
 
If not listed above, please enter below:  
 
Country: 
 
If not listed above, please enter below:  
 
Zip or Postal Code: 
   
Phone  Numbers: 
Country Code ("1" for US and Canada)
Area Code or Intl City Code (if reqd.)
Your Local Number
Phone: 
  - -  
E-mail: 
 
Comments:

The above information change will be processed upon submission. Please allow two weeks for all changes to be processed. You may also call us at
610-667-0131 to make changes. Thank you, GBS/CIDP Foundation International.


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The Holly Building - 104 1/2 Forrest Avenue - Narberth, PA 19072
Phone: 610-667-0131 - Fax: 610-667-7036

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