{"id":3634,"date":"2023-11-16T13:02:10","date_gmt":"2023-11-16T13:02:10","guid":{"rendered":"https:\/\/pku.biomarin.com\/en-us\/?page_id=3634"},"modified":"2025-11-13T11:52:26","modified_gmt":"2025-11-13T11:52:26","slug":"pku-me-registration","status":"publish","type":"page","link":"https:\/\/pku.biomarin.com\/en-us\/pku-me-registration\/","title":{"rendered":"PKU &#038; ME Registration"},"content":{"rendered":"<div id=\"acf-block-655612d237d7b\" class=\"block pkuandme-form-block\">\n    <div class=\"wrapper\">\n        <div class=\"inner-wrapper\">\n            <div class=\"above-form-copy\">\n                                    <h2>PKU &amp; ME Registration\n<\/h2>\n                                                    <p>Fill in below to start exploring the benefits that PKU &amp; ME has to offer.<\/p>\n<p>* Required fields.<\/p>\n                            <\/div>\n\n            <div class=\"block form-box\">\n                <form id=\"pkuandme-sign-up\" name=\"Sign Up to Stay in the Know!\" data-success=\"https:\/\/pku.biomarin.com\/en-us\/pku-me-registration\/thank-you\/\">\n                    <div class=\"form-columns form-columns-stretch\">\n                        <div class=\"form-item-box large-check-box\">\n                            <div class=\"large-checkbox-header large-checkbox-header-email\">\n                                <input type=\"checkbox\" name=\"send-me-email\" id=\"send-me-email\" checked disabled>\n                            <\/div>\n                            <label for=\"send-me-email\">Send me emails about better living with PKU<\/label>\n                            <p>Join the PKU &amp; Me program to receive:<\/p>\n                            <ul>\n                                <li>Advice on PKU management<\/li>\n                                <li>PKU-friendly recipes<\/li>\n                                <li>Stories from the community<\/li>\n                                <li>The latest news about PKU<\/li>\n                            <\/ul>\n                        <\/div>\n                        <div class=\"form-item-box large-check-box\">\n                            <div class=\"large-checkbox-header large-checkbox-header-rep\">\n                                <input type=\"checkbox\" name=\"rep-contact-me\" id=\"rep-contact-me\">\n                            <\/div>\n                            <label for=\"rep-contact-me\">Connect with a BioMarin representative<\/label>\n                            <p>Ask your PKU questions and get personal help with:<\/p>\n                            <ul>\n                                <li>Access to resources<\/li>\n                                <li>Disease education<\/li>\n                                <li>PKU events (live and virtual)<\/li>\n                            <\/ul>\n                        <\/div>\n                    <\/div>\n\n                    <div class=\"form-item\">\n                        <p>*Required<\/p>\n                    <\/div>\n\n                    <div class=\"form-item\">\n                        <label for=\"contact-type\">What best describes you?<span class=\"required\">*<\/span><\/label>\n                        <select class=\"text\" id=\"contact-type\" required\n                        data-pristine-required-message=\"Please select an option\">\n                            <option value=\"\">Please select an option<\/option>\n                            <option value=\"Patient\">I have PKU<\/option>\n                            <option value=\"Caregiver\">I support someone with PKU who is over 18<\/option>\n                            <option value=\"Caregiver\">I support someone with PKU who is under 18<\/option>\n                        <\/select>\n                    <\/div>\n\n                    <div class=\"form-columns\">\n                        <div class=\"form-item\">\n                            <label for=\"first-name\">First name<span class=\"required\">*<\/span><\/label>\n                            <input class=\"text\" id=\"first-name\" type=\"text\" required\n                            data-pristine-required-message=\"Please enter your first name\">\n                        <\/div>\n                        <div class=\"form-item\">\n                            <label for=\"last-name\">Last name<span class=\"required\">*<\/span><\/label>\n                            <input class=\"text\" id=\"last-name\" type=\"text\" required\n                            data-pristine-required-message=\"Please enter your last name\">\n                        <\/div>\n                    <\/div>\n\n                    <div class=\"form-item\">\n                        <label for=\"email\">Email address<span class=\"required\">*<\/span><\/label>\n                        <input class=\"text\" id=\"email\" type=\"email\" required data-pristine-required-message=\"Please enter your email address\">\n                    <\/div>\n\n                    <div class=\"form-item\">\n                        <label for=\"dob\">Date of birth of the person with PKU<span class=\"required\">*<\/span><\/label>\n                        <input class=\"text\" id=\"dob\" type=\"text\" placeholder=\"mm\/dd\/yyyy\" required\n                        data-pristine-required-message=\"Please enter your date of birth\">\n                    <\/div>\n\n                    <div class=\"form-item form-item-title\">\n                        <p class=\"label\">Is the person with PKU currently on treatment?<span class=\"required\">*<\/span><\/p>\n                    <\/div>\n                    <div class=\"form-columns\">\n                        <div class=\"form-item linear-radio\">\n                            <label for=\"on-treatment-yes\">Yes<\/label>\n                            <input name=\"on-treatment\" id=\"on-treatment-yes\" type=\"radio\" value=\"yes\">\n                        <\/div>\n\n                        <div class=\"form-item linear-radio\">\n                            <label for=\"on-treatment-no\">No<\/label>\n                            <input name=\"on-treatment\" id=\"on-treatment-no\" type=\"radio\" value=\"no\">\n                        <\/div>\n                    <\/div>\n\n                    <div class=\"form-item\">\n                        <label for=\"phone-number\">Phone number<\/label>\n                        <input class=\"text\" id=\"phone-number\" type=\"text\"\n                        data-pristine-required-message=\"Please enter your phone number\"\n                        data-pristine-pattern-message=\"Please enter a valid phone number\"\n                        data-pristine-pattern=\"\/^\\(?([0-9]{3})\\)?[-. ]?([0-9]{3})[-. ]?([0-9]{4})$\/\">\n                    <\/div>\n\n                    <div class=\"form-item\">\n                        <label for=\"zip-code\">Zip Code<span class=\"required\">*<\/span><\/label>\n                        <input class=\"text\" id=\"zip-code\" type=\"text\" required\n                        data-pristine-required-message=\"Please enter your ZIP code\"\n                        data-pristine-pattern-message=\"Please enter a valid ZIP code\"\n                        data-pristine-pattern=\"\/^\\d{5}(-\\d{4})?$\/i\">\n                    <\/div>\n\n                    <div class=\"form-item\">\n                        <label for=\"address\">Address 1<\/label>\n                        <input class=\"text\" id=\"address\" type=\"text\"\n                        data-pristine-required-message=\"Please enter your address\">\n                    <\/div>\n\n                    <div class=\"form-item\">\n                        <label for=\"address2\">Address 2<\/label>\n                        <input class=\"text\" id=\"address2\" type=\"text\">\n                    <\/div>\n\n                    <div class=\"form-item\">\n                        <label for=\"city\">City<\/label>\n                        <input class=\"text\" id=\"city\" type=\"text\"\n                        data-pristine-required-message=\"Please enter your city\">\n                    <\/div>\n\n                    <div class=\"form-item\">\n                        <label for=\"state\">State<\/label>\n                        <select class=\"text\" id=\"state\"\n                        data-pristine-required-message=\"Please select your state\">\n                            <option value=\"\">Please select your state<\/option>\n                            <option value=\"AL\">Alabama<\/option>\n                            <option value=\"AK\">Alaska<\/option>\n                            <option value=\"AZ\">Arizona<\/option>\n                            <option value=\"AR\">Arkansas<\/option>\n                            <option value=\"CA\">California<\/option>\n                            <option value=\"CO\">Colorado<\/option>\n                            <option value=\"CT\">Connecticut<\/option>\n                            <option value=\"DE\">Delaware<\/option>\n                            <option value=\"DC\">District of Columbia<\/option>\n                            <option value=\"FL\">Florida<\/option>\n                            <option value=\"GA\">Georgia<\/option>\n                            <option value=\"GU\">Guam<\/option>\n                            <option value=\"HI\">Hawaii<\/option>\n                            <option value=\"ID\">Idaho<\/option>\n                            <option value=\"IL\">Illinois<\/option>\n                            <option value=\"IN\">Indiana<\/option>\n                            <option value=\"IA\">Iowa<\/option>\n                            <option value=\"KS\">Kansas<\/option>\n                            <option value=\"KY\">Kentucky<\/option>\n                            <option value=\"LA\">Louisiana<\/option>\n                            <option value=\"ME\">Maine<\/option>\n                            <option value=\"MD\">Maryland<\/option>\n                            <option value=\"MA\">Massachusetts<\/option>\n                            <option value=\"MI\">Michigan<\/option>\n                            <option value=\"MN\">Minnesota<\/option>\n                            <option value=\"MS\">Mississippi<\/option>\n                            <option value=\"MO\">Missouri<\/option>\n                            <option value=\"MT\">Montana<\/option>\n                            <option value=\"NE\">Nebraska<\/option>\n                            <option value=\"NV\">Nevada<\/option>\n                            <option value=\"NH\">New Hampshire<\/option>\n                            <option value=\"NJ\">New Jersey<\/option>\n                            <option value=\"NM\">New Mexico<\/option>\n                            <option value=\"NY\">New York<\/option>\n                            <option value=\"NC\">North Carolina<\/option>\n                            <option value=\"ND\">North Dakota<\/option>\n                            <option value=\"OH\">Ohio<\/option>\n                            <option value=\"OK\">Oklahoma<\/option>\n                            <option value=\"OR\">Oregon<\/option>\n                            <option value=\"PA\">Pennsylvania<\/option>\n                            <option value=\"RI\">Rhode Island<\/option>\n                            <option value=\"SC\">South Carolina<\/option>\n                            <option value=\"SD\">South Dakota<\/option>\n                            <option value=\"TN\">Tennessee<\/option>\n                            <option value=\"TX\">Texas<\/option>\n                            <option value=\"UT\">Utah<\/option>\n                            <option value=\"VT\">Vermont<\/option>\n                            <option value=\"VA\">Virginia<\/option>\n                            <option value=\"WA\">Washington<\/option>\n                            <option value=\"WV\">West Virginia<\/option>\n                            <option value=\"WI\">Wisconsin<\/option>\n                            <option value=\"WY\">Wyoming<\/option>\n                        <\/select>\n                    <\/div>\n\n                    <div class=\"form-item check-item\">\n                        <input type=\"checkbox\" id=\"accept-ts-cs\" name=\"accept_ts_cs\" required\n                        data-pristine-required-message=\"Please agree to the terms of use\">\n                        <label for=\"accept-ts-cs\">By checking this box and clicking SUBMIT below, I confirm I am least 18 years old; confirm I agree to BioMarin&#8217;s <a href=\"https:\/\/www.biomarin.com\/data-privacy-center\/\" target=\"_blank\">Privacy Policy and CCPA Notice<\/a> and <a href=\"https:\/\/www.biomarin.com\/terms-of-use\/en-us\/\" target=\"_blank\">Terms of Use<\/a>; consent to BioMarin, its successors, agents, and\/or assigns using the email address and\/or phone number I have provided, including via use of an automatic telephone dialing system, to keep me informed about news and developments, market research or surveys, or other opportunities that may be of interest to me; confirm I understand these communications\/materials may contain information that markets or advertises BioMarin products, goods, or services; confirm I understand I am not required to provide my consent as a condition of purchasing or renting any products, goods, or services; and confirm I understand I may opt out of receiving such communications in the future via links in them.<\/label>\n                    <\/div>\n\n                    <div class=\"form-item\">\n                        <input type=\"submit\" class=\"button\" value=\"Submit\">\n                    <\/div>\n                <\/form>\n                <form id=\"mktoForm_3470\" style=\"display:none;\"><\/form>\n            <\/div>\n        <\/div>\n    <\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-3634","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.1.1 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>PKU &amp; ME Registration - BioMarin PKU DSE Patient EN-US<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/pku.biomarin.com\/en-us\/pku-me-registration\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"PKU &amp; ME Registration - BioMarin PKU DSE Patient EN-US\" \/>\n<meta property=\"og:url\" content=\"https:\/\/pku.biomarin.com\/en-us\/pku-me-registration\/\" \/>\n<meta property=\"og:site_name\" content=\"BioMarin PKU DSE Patient EN-US\" \/>\n<meta property=\"article:modified_time\" content=\"2025-11-13T11:52:26+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/pku.biomarin.com\/en-us\/pku-me-registration\/\",\"url\":\"https:\/\/pku.biomarin.com\/en-us\/pku-me-registration\/\",\"name\":\"PKU & ME Registration - BioMarin PKU DSE Patient EN-US\",\"isPartOf\":{\"@id\":\"https:\/\/pku.biomarin.com\/en-us\/#website\"},\"datePublished\":\"2023-11-16T13:02:10+00:00\",\"dateModified\":\"2025-11-13T11:52:26+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/pku.biomarin.com\/en-us\/pku-me-registration\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/pku.biomarin.com\/en-us\/pku-me-registration\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/pku.biomarin.com\/en-us\/pku-me-registration\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/pku.biomarin.com\/en-us\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"PKU &#038; ME Registration\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/pku.biomarin.com\/en-us\/#website\",\"url\":\"https:\/\/pku.biomarin.com\/en-us\/\",\"name\":\"BioMarin PKU DSE Patient EN-US\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/pku.biomarin.com\/en-us\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"PKU & ME Registration - BioMarin PKU DSE Patient EN-US","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/pku.biomarin.com\/en-us\/pku-me-registration\/","og_locale":"en_US","og_type":"article","og_title":"PKU & ME Registration - BioMarin PKU DSE Patient EN-US","og_url":"https:\/\/pku.biomarin.com\/en-us\/pku-me-registration\/","og_site_name":"BioMarin PKU DSE Patient EN-US","article_modified_time":"2025-11-13T11:52:26+00:00","twitter_card":"summary_large_image","schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/pku.biomarin.com\/en-us\/pku-me-registration\/","url":"https:\/\/pku.biomarin.com\/en-us\/pku-me-registration\/","name":"PKU & ME Registration - BioMarin PKU DSE Patient EN-US","isPartOf":{"@id":"https:\/\/pku.biomarin.com\/en-us\/#website"},"datePublished":"2023-11-16T13:02:10+00:00","dateModified":"2025-11-13T11:52:26+00:00","breadcrumb":{"@id":"https:\/\/pku.biomarin.com\/en-us\/pku-me-registration\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/pku.biomarin.com\/en-us\/pku-me-registration\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/pku.biomarin.com\/en-us\/pku-me-registration\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/pku.biomarin.com\/en-us\/"},{"@type":"ListItem","position":2,"name":"PKU &#038; ME Registration"}]},{"@type":"WebSite","@id":"https:\/\/pku.biomarin.com\/en-us\/#website","url":"https:\/\/pku.biomarin.com\/en-us\/","name":"BioMarin PKU DSE Patient EN-US","description":"","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/pku.biomarin.com\/en-us\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"}]}},"_links":{"self":[{"href":"https:\/\/pku.biomarin.com\/en-us\/wp-json\/wp\/v2\/pages\/3634","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pku.biomarin.com\/en-us\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/pku.biomarin.com\/en-us\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/pku.biomarin.com\/en-us\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/pku.biomarin.com\/en-us\/wp-json\/wp\/v2\/comments?post=3634"}],"version-history":[{"count":3,"href":"https:\/\/pku.biomarin.com\/en-us\/wp-json\/wp\/v2\/pages\/3634\/revisions"}],"predecessor-version":[{"id":4522,"href":"https:\/\/pku.biomarin.com\/en-us\/wp-json\/wp\/v2\/pages\/3634\/revisions\/4522"}],"wp:attachment":[{"href":"https:\/\/pku.biomarin.com\/en-us\/wp-json\/wp\/v2\/media?parent=3634"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}