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LHON Canada Membership Registration


Membership in LHON Canada is free.  We keep track of events in LHON community world wide and pass the information on to you via email.  To help us better serve your needs, please fill in the membership form below.

Thank you!

Contact Information
(This question is mandatory)
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Email Address
General Information
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What is your preferred language?
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I am a __________? 
To help LHON Canada better meet your needs, which of the following types of information would you be interested in receiving by email
What is your Birth Year (enter 4 digits)
(This question is mandatory)
I agree to be added to the LHON Canada Electronic Mailing List. You may unsubscribe at any time.
Affected / Carrier Information
                                                               **The following 5 questions are ONLY for those who are Affected OR are Carriers**
What sex were you assigned at birth on your orginal birth certificate?
In what year did your symptoms, if any start? (enter 4 digits)
Please specify your LHON mutation 
How many others in your extended family that you are aware of have or have had LHON symptoms?