Become a PNWBD Member

Join the PNWBD Community!

PNWBD serves people living with Hemophilia, von Willebrand Disease, and other rare bleeding disorders. Our service area includes Oregon and counties in Southwest Washington. We provide education, advocacy, and many other services to help our members manage their disease and improve their quality of life.
PNWBD is a non-profit organization dedicated to providing education and support to families affected by bleeding disorders. By supplying your information, you will be notified of upcoming educational and social events, programs specific to your diagnosis, opportunities withing the community and support services. Membership is FREE for people with bleeding disorders and their immediate family members. To register with PNWBD, please complete the form below.

Information collected on this Jotform is HIPPA protected and complies with the set of rules and regulations that protect your security, privacy, and health information. For more information, Click Here.
Your Name*

First NameLast Name
Your Birthday*

MonthDayYear
How did you hear about PNWBD?*

The Hemostasis and Thrombosis Center at OHSUWeb SearchFriend or Family MemberFrom another Bleeding Disorder ChapterOther:
Tell Us more about You - Check all that Apply*

I have a Bleeding DisorderI am a Hemophilia CarrierI am part of the Hemostasis and Thrombosis CenterI am a caregiver and/or have family member(s) who have a bleeding disorderIf none of the above options were selected, please tell us how you fit into the bleeding disorder community.
Bleeding Disorder and Severity
Phone Number*
E-mail*
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Preference for PNWBD Newsletters, Invites, Opportunities, Updates and more...*

Email and USPS MailEmail OnlyUSPS Mail OnlyNo mail please
Add Family/Household Members to your Profile
Questions and Additional Information you would like to share
Questions will be answered within 3-5 business days to the email provided.
Should be Empty:

Join the PNWBD Community!