RSVP Here for VIRTUAL – Virginia General Assembly Weekly Check In
Tues., Jan 14, Tues., Feb 4, Tues., Feb 11, Tues., Feb 18 12:00 – 12:30 PM
Attendee Information
Please fill name and contact information of attendees.
Your Name
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First Name
Last Name
Email Address
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example@example.com
Cell Phone Number
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Please enter a valid phone number.
Is this your first Virginia Hemophilia Foundation (VHF) or Hemophilia Association of the Capital Area (HACA) event/program?
No
Yes
I'm unsure
If You Answered "Yes" or "I'm unsure" - Please Provide Your Current Physical Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
If You Answered "Yes" or "I'm unsure" - Please Let Us Know How You Heard About Us
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Referred by HTC
Referred by other healthcare provider
Referred by friend or family member
Recently moved to the area
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