Order Your Family and
VIP Siblings Kit

Only registered members of the PCDH19 Alliance who reside in the U.S. may register to receive a VIP Sibling Kit. You can contact us to become a member or check your membership status.

The information collected by the PCDH19 Alliance will not be sold or distributed outside of the Alliance and is used solely to verify the identity of and to communicate with sibling member families as needed. Reach out with questions or concerns.

 

Kit Order Form

Parent or Guardian Name(Required)
I am a member of the Alliance Facebook Support Group(Required)
Only registered members of the PCDH19 Facebook Support Group who reside in the U.S. may register to receive a VIP Sibling Kit. If you are not a member you will be contacted about how to become one. If you are outside of the U.S., many of the resources can be accessed digitally to be downloaded or printed here vipsibling.com.
I would like to request a Parent & Caregiver resource kit(Required)
I would like to request VIP Sibling kit(s)(Required)
For more than 4 siblings, please complete an additional form.
Sibling 1 first and last name(Required)
Which kit for Sibling 1(Required)
Sibling 2 first and last name
Which kit for Sibling 2
Sibling 3 first and last name
Which kit for Sibling 3
Sibling 4 first and last name
Which kit for Sibling 4
Address where kit(s) should be mailed:(Required)