Form No number No number ALS Registration

National Amyotrophic Lateral Sclerosis (ALS) Registry

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0923-0041 can be found here:

Document [doc]

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Form Approved

OMB No. 0923-XXXX

Exp. Date xx/xx/20xx

Attachment 5

Screen Shot of the Registration Page