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Registration is easy—simply fill out the quick form below to let us know a little more about you. The answers you provide will help us bring you relevant and timely MS information.

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Email Address:*
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Password:*		(must be 5-15 characters)
Retype Password:*
Password Hint:*		(If you forget your password, we will show you this hint as a reminder.)
First Name: *
Last Name: *
Address 1:*
Address 2:		(Optional)
City:*
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Gender:	Female Male

Phone:*

Home Phone:	- -
Cell Phone:	- -

Which of the following describes you?*

	Person with MS
	Family Member or Caregiver
	Healthcare Professional

If you have MS, please answer the following
If you are a Family Member or Caregiver, please answer the following about the person you know with MS.
	Birth Date:
	When were you diagnosed?*
	Current Therapy:*
	Current Therapy Start Date:*

Are you satisfied with your current MS medication? *
	Yes No

If no, why are you dissatisfied? *

What other MS medication(s) have you tried? (Check all that apply)*
	AVONEX^® (Interferon beta-1a) TYSABRI^® (natalizumab) Betaseron^® (Interferon beta-1b) Other	Rebif^® (Interferon beta-1a) Copaxone^® (glatiramer acetate injection) None

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*I have read and understand the Disclaimer and Privacy Policy

By checking this box, you indicate that you would like to receive information on Biogen Idec products, services, programs, and health-related topics.**

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** I authorize Biogen Idec, and companies working with Biogen Idec, to provide me with information about, or ask me about my experience with or thoughts about, products, services, and programs that Biogen Idec offers or sponsors. I understand and agree that any information I provide may be used by Biogen Idec to help develop new products, services, and programs. I understand and agree that Biogen Idec, and companies working with Biogen Idec, may contact me by mail, email, and/or telephone.

I understand that I can choose to opt out of any future contacts at any time by giving notice by phone at 1-800-456-2255 or by mailing a letter to: Biogen Idec Patient Services, 5000 Davis Drive, P.O. Box 13919, Research Triangle Park, NC 27709-3919.

Please see full Prescribing Information, including Boxed Warning and Patient Medication Guide.

Please see full Avonex Prescribing Information and Avonex Patient Medication Guide.

About TYSABRI | Your MS Treatment with TYSABRI | Connect with People Taking TYSABRI | Living with Multiple Sclerosis

TOUCH and TYSABRI are registered trademarks of Elan Pharmaceuticals, Inc.

BIOGEN IDEC and the BIOGEN IDEC logo are registered trademarks of Biogen Idec.

The ELAN logo is a registered trademark of Elan Corporation, plc.