SCAK Participation Survey

I have SCDI have SCTI don't have either, but I know someone who does have SCD/T.I don't have either, but I (want to) support the community.I don't know my status

Are there other supports or accommodations that you would need to attend a SCAK function?

YesNo

If you answered no, thank you for your time. You will NOT be contacted. Please submit this form or if this is a paper copy, turn it back into one of the attendants at the SCAK booth. Thank you for taking your time to help us provide better support to the Sickle Cell Community!

If you answered YES, please continue to fill out the form so that we can contact you at a later time. Thank your filling out this form, as well as your willingness to talk with us!

Name

First NameLast Name

EmailPhoneText

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.