Register

How to register?

Anyone who is directly or indirectly involved with ALS can register for free with the League. You will then be kept informed of everything happening within the ALS world through our monthly ALS Newsletter, if you wish.

pALS who are registered (click below on the Patient tab) can also make free use of our aids. Of course, you are welcome to make a voluntary contribution.

Family members, friends, and others who wish to be better informed about ALS (click below on the Family Member or Other tab) and everything related to it, such as aids, benefits, adjustments, research, and so on, may always contact us. We will do our best to answer all your questions.

Contact details

These personal details allow us to include you in our patient database, identify you, and communicate with you.

I consent

Name

First name

Date of birth

National registration number

Street + number

Postal code

Municipality

Phone/Cellphone

E-mail

ALS

The personal data regarding your health or that of the ALS patient for whom the registration is being made gives us insight into the nature and condition of ALS. The knowledge of this personal data ensures that we can adequately inform and guide you in the context of the services we offer.

I consent

Onset and nature of ALS

General practitioner

Neurologist

Hospital

Speech therapist

Physiotherapist

Other

Wishes to participate in an ALS media campaign
YesNo

Employer

Partner
YesNo

Please provide the following details of your partner:

Name

First name

Date of birth

Partner’s employer

I agree with the terms of use and the privacy policy

Our new campaign is live!Find out how we want to make a difference together with you.Check it out here, read all about it and be sure to check out our spot!

Register

How to register?

Our new campaign is live!
Find out how we want to make a difference together with you.
Check it out here, read all about it and be sure to check out our spot!