Raise awareness year-round!

Use the form below to participate in our ongoing campaign to highlight individuals living with ASXL-related disorders.

We will post a series of sharable graphics about individuals with ASXL-related disorders on the ARRE Foundation's Facebook, Instagram, Twitter, and LinkedIn accounts.

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Sample graphic

Sample graphic
Tell us about your loved one who has an ASXL-related disorder!

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* My loved one has:

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* About your loved one (45 character limit with spaces)

Photo upload

Please upload up to three of your favorite photos of your loved one. Please don't crop images - we'll handle that!

This form accepts the following file types: PNG, JPG, JPEG or GIF files.

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* Photo 1 - file upload

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* Photo 2 - file upload

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* Photo 3 - file upload

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File
Name of parent/guardian

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* First name

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* Last name

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* Email address

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* May we add you to our email list?

Consent to use your photos and quotations
Below is a description of how we may use your family's photos and quotations. 

How are images, stories and testimonials used?
We use images and stories in a range of materials to promote the ARRE Foundation. This includes (but is not limited to) advertisements and publicity materials (leaflets, brochures, posters, direct mail and publications for the Internet). The ARRE Foundation will retain copyright of the image and story as part of materials to promote their work.

How long does consent last?
Consent continues with no time limit. Image and story consent can be changed or withdrawn at any time. We cannot withdraw images and stories already published.

Who can give consent?
Only a parent/legal guardian can give consent.
Consent agreement
I agree to the  ASXL Rare Research Endowment Foundation (ARRE Foundation) using the image(s) and/or story and give hereby the ARRE Foundation permission to publish, use and republish the attached material, in whole or in part, in publications which describe the Foundation’s programs, funds and any of its activities as a community foundation.

The said material may include a photograph(s), video(s), stories, quotes and testimonials (written, audio or video recorded).

The said material may be used before a variety of audiences which may include the ARRE Foundation’s staff and directors, current and potential donors and grantees of the ARRE Foundation, the news media and the general public. Publication may appear in newsletters, annual reports, brochures, posters, website pages, social media or other forms of literature, including electronic and print.

I understand that I may withdraw this consent at any time by forwarding such request, in writing, to the ARRE Foundation.
Signature
By typing your name below, you are agreeing to the terms of the consent agreement

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* Signature of parent/guardian

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* Today's date

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Optional information

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* Your address

T