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Living Rare Study: NORD Member Enrollment Survey
Living Rare Study: NORD Member Enrollment Survey
1. Organization Name
(Required)
2. Organization Point of Contact:
Name
(Required)
First
Last
Email
(Required)
Phone
(Required)
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
3. Does a registry exist for the rare disease(s) represented by your organization?
(Required)
Yes
No
Unknown
If so, does your organization maintain this registry?
(Required)
Yes
No
If yes, what registry platform is your organization currently utilizing?
(Required)
4. What barriers prevent your organization from maintaining its own registry? (Select all that apply)
(Required)
Cost
Staff capacity
Expertise
Limited patient population
Competing priorities
Other
If other, what barriers prevent your organization from maintaining its own registry?
(Required)
Disease Population
Disease(s) Represented
(Required)
Type at least the first 5 letters of the disease name, and do not use an acronym.
2. Do any of the diseases represented by your organization impact fewer than 7,000 people in the United States?
(Required)
Yes
No
Not sure
Organizational Capacity
1. Year organization established
(Required)
2. # of Full time Employees
(Required)
3. # of Part time Employees
(Required)
4. # of Volunteer Employees
(Required)
5. Annual Budget
(Required)
Impact
1. How important would access to aggregate community data be for your organization?
(Required)
Extremely important
Very important
Moderately important
Slightly important
Not important
How does your organization plan to use aggregate Living Rare data?
(Required)
Focus Group Invitation
1. Would your organization like to participate in a focus group or round table to discuss which fields to include in reports?
(Required)
Yes
No
Terms and Conditions
By enrolling as a Living Rare Partner, the Advocacy Organization acknowledges and agrees that:
(Required)
The Advocacy Organization's role is limited to sharing information about the Living Rare Study and directing interested individuals to the National Organization for Rare Disease’s Living Rare Study Team. The Advocacy Organization is not considered part of the research team and is not responsible for conducting any study activities.
The Advocacy Organization will use only recruitment materials and messaging provided by the National Organization for Rare Disorders and will not modify any of the study-related materials.
The Advocacy Organization will not offer payments, gifts, or other incentives to encourage participation in the Living Rare Study.
If enough participants who report a diagnosis of the disease represented by the Advocacy Organization enroll in Living Rare (at least 25 participants), the National Organization for Rare Disorders may provide an aggregate, de-identified summary report. Receipt of a disease-specific report is not guaranteed and depends on meeting the minimum participation threshold and having sufficient data available to generate a meaningful report while protecting participant privacy.
NORD staff is committed to developing reports that are meaningful and useful to participating organizations. Report format and content may be refined over time based on feedback from partner organizations, data availability, and privacy requirements. NORD will ultimately determine the final content of all reports.
Organizations may enroll as partners throughout the year; however, all partnerships expire on December 31st of the year in which they are established. Organizations wishing to continue participating must complete any renewal requirements established by the National Organization for Rare Disorders.
The National Organization for Rare Disorders reserves the right to modify or terminate a partnership if these requirements are not followed or if continued participation is inconsistent with privacy, regulatory, or other study-related requirements.
I certify that I am authorized to enroll this organization as a Living Rare Partner and agree to the acknowledgements above on behalf of the organization.