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2018 Chip for Charity Raises $125,000
Thanks to our wonderful friends for their unwavering support last year!
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The SSADH Family Registration Form is a multiple step process using a separate form for each family member. On the form located below, please enter the information relating to your affected child (if you have more than one affected child, you will be able to enter the second child after clicking the Continue button). After completing the affected child information and clicking the Continue button, you will be able to enter additional information for each family.
* required information
Affected Child 
Information
First Name:*
Last Name:*
Address Line 1:*
Address Line 2:
City:*
State:*
Province:
ZIP/Postal Code:*
Country:*
Email:*
Phone:
Birth Date:*(mm/dd/yyyy)
Gender: Female   Male  
What Diagnosis have you received?: Succinic Semialdehyde Dehydrogenase Deficiency (SSADH)
Undiagnosed
After providing all requested information for your affected child, please click on the continue button below to provide information on other family members