Parkinson's Engagement Network Sign-up

First name *

Last name *

Email address *

City/Town *

Country *

Gender *

Female
Male
Other
Do not wish to disclose

Ethnicity *

What languages do you speak/read?

The emails you will receive will mostly be in English, are you happy with this?

Yes
No

Is this a barrier for you?

Yes
No

Are you a *

Person diagnosed with Parkinson's or P+
Partner or caregiver
Supporter or family member
Professional with an interest in Parkinson’s
Healthcare professional
Researcher or working in research
Influencer
Other

What’s your diagnosis?

When were you diagnosed?

Have you had genetic testing done

Yes
No

What professional group do you identify as?

Are you linked to an organisation? *

Yes
No

Please provide the name of the organisation(s)

Is it a

If relevant, please provide your job title/role in that organisation

What opportunities are you interested in receiving from us via email? (tick as many as apply) *

Consulting about or shaping activities and projects
Advocacy activities
Personal experience and insight activities
Research activities - shaping research or taking part
Education and learning opportunities

By ticking this box you agree to the storage of your contact details and preferences by Parkinson's Europe, for the provision of communication services. All information on how we handle your data can be found in our privacy policy. *

Parkinson's Engagement Network Sign-up

Become part of a network which connects all kinds of people and organisations from across Europe, giving you the opportunity to actively choose to get involved in changing the future of Parkinson's.

Sign up to our Engagement Network

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