{"id":3634,"date":"2023-11-16T13:02:10","date_gmt":"2023-11-16T13:02:10","guid":{"rendered":"https:\/\/pkudsepatient-dev-001.azurewebsites.net\/en-us\/?page_id=3634"},"modified":"2024-02-14T17:20:00","modified_gmt":"2024-02-14T17:20:00","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!\">\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                \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<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-columns\">\n                        <div class=\"form-item\">\n                            <label for=\"dob\">Patient date of birth<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\">\n                            <label for=\"address\">Address<\/label>\n                            <input class=\"text\" id=\"address\" type=\"text\"\n                            data-pristine-required-message=\"Please enter your address\">\n                        <\/div>\n                    <\/div>\n                    \n                    <div class=\"form-columns\">\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                    <\/div>\n                \n                    <div class=\"form-columns\">\n                        <div class=\"form-item\">\n                            <label for=\"zip-code\">US postal 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})?$\/i\">\n                        <\/div>\n                \n                        <div class=\"form-item\">\n                            <label for=\"phone-number\">Phone number<\/label>\n                            <input class=\"text\" id=\"phone-number\" type=\"text\"\n                            data-pristine-required-message=\"Please enter your phone number\"\n                            data-pristine-pattern-message=\"Please enter a valid phone number\"\n                            data-pristine-pattern=\"\/^\\(?([0-9]{3})\\)?[-. ]?([0-9]{3})[-. ]?([0-9]{4})$\/\">\n                        <\/div>\n                    <\/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=\"Support\">I help support a person with PKU who is on treatment<\/option>\t\t\t\t\t\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 at least 18 years old; confirm I agree to BioMarin&rsquo;s <a target=\"_blank\" href=\"https:\/\/www.biomarin.com\/data-privacy-center\/\">Privacy Policy and CCPA Notice<\/a> and <a target=\"_blank\" href=\"https:\/\/medinfoterms.com\/\">Terms of Use<\/a>; consent to BioMarin, its successors, agents, and\/or assigns using the email address I have provided to keep me informed about news and developments, market research or surveys, or other opportunities that may be of interest to me; and confirm I understand these communications\/materials may contain information that markets or advertises BioMarin products, goods, or services.<\/label>\n                    <\/div>\n                \n                    <div class=\"form-item check-item\">\n                        <input type=\"checkbox\" id=\"rep-contact-me\" name=\"rep_contact_me\">\n                        <label for=\"rep-contact-me\">By checking this box and clicking SUBMIT below, I consent to BioMarin, its successors, agents, and\/or assigns using the phone number I have provided to phone and\/or text me with communications\/messages that contain information marketing BioMarin\u2019s products, goods, or services, including via use of an automatic telephone dialing system; and confirm I understand I am not required to provide my consent as a condition of purchasing or renting any products, goods, or services.<\/label>\n                    <\/div>\t\t\t\t\t\n                \n                    <div class=\"form-item\">\n                        <input type=\"submit\" class=\"button\" value=\"Sign up\">\n                    <\/div>\n                <\/form>\n                <form id=\"mktoForm_3470\" style=\"display:none;\"><\/form>\n            <\/div>\n\n            <div class=\"block form-success-confirmation\" style=\"display:none;\">\n                                    <h3>Thank you!<\/h3>\n<p>We&#8217;ll be in touch soon with additional information.<\/p>\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":""},"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.1 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Register for PKU &amp; Me | PKU - Phenylketonuria<\/title>\n<meta name=\"description\" content=\"Complete registration to start exploring the benefits that PKU &amp; ME has to offer.\" \/>\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=\"Register for PKU &amp; Me | PKU - Phenylketonuria\" \/>\n<meta property=\"og:description\" content=\"Complete registration to start exploring the benefits that PKU &amp; ME has to offer.\" \/>\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=\"2024-02-14T17:20:00+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\":\"Register for PKU & Me | PKU - Phenylketonuria\",\"isPartOf\":{\"@id\":\"https:\/\/pku.biomarin.com\/en-us\/#website\"},\"datePublished\":\"2023-11-16T13:02:10+00:00\",\"dateModified\":\"2024-02-14T17:20:00+00:00\",\"description\":\"Complete registration to start exploring the benefits that PKU & ME has to offer.\",\"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\":\"PKU - Phenylketonuria\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/pku.biomarin.com\/en-us\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Register for PKU & Me | PKU - Phenylketonuria","description":"Complete registration to start exploring the benefits that PKU & ME has to offer.","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":"Register for PKU & Me | PKU - Phenylketonuria","og_description":"Complete registration to start exploring the benefits that PKU & ME has to offer.","og_url":"https:\/\/pku.biomarin.com\/en-us\/pku-me-registration\/","og_site_name":"BioMarin PKU DSE Patient EN-US","article_modified_time":"2024-02-14T17:20:00+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":"Register for PKU & Me | PKU - Phenylketonuria","isPartOf":{"@id":"https:\/\/pku.biomarin.com\/en-us\/#website"},"datePublished":"2023-11-16T13:02:10+00:00","dateModified":"2024-02-14T17:20:00+00:00","description":"Complete registration to start exploring the benefits that PKU & ME has to offer.","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":"PKU - Phenylketonuria","description":"","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/pku.biomarin.com\/en-us\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"}]}},"_links":{"self":[{"href":"https:\/\/pku.biomarin.com\/en-us\/wp-json\/wp\/v2\/pages\/3634"}],"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":3912,"href":"https:\/\/pku.biomarin.com\/en-us\/wp-json\/wp\/v2\/pages\/3634\/revisions\/3912"}],"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}]}}