RSVP for VHF Women's Retreat Weekend

RSVP for VHF Women's Retreat Weekend

Saturday, February 15 - Sunday, February 16, 2025
Eligibility: The VHF Women’s Retreat is designed for VHF constituents age 21 and up with inherited bleeding disorders and/or to adults whose lives are impacted by an inherited bleeding disorder (i.e. caregivers, spouses, carriers, immediate family members – some restrictions do apply) and is not open to individuals employed or compensated by Industry.

VHF Behavior and Program Registration Guidelines: Please read VHF's Behavior and Program Registration Guidelines before filling out application. If you have any questions, please email info@vahemophilia.org or call 804-740-8643.
Attendee Information

Please fill name and contact information of attendees.
Your Name*

First NameLast Name
Email Address*
example@example.com
Cell Phone Number*
Please enter a valid phone number.
Is this your first Virginia Hemophilia Foundation (VHF) event/program?*

No.Yes.I am unsure.
If You Answered "Yes" or "I'm unsure" - Please Provide Your Current Physical Address.*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If You Answered "Yes" or "I'm unsure" - Please Let Us Know How You Heard About Us.*

Referred by CHKD-HTC.Referred by UVA-HTC.Referred by VCU-HTC.Referred by other healthcare provider.Referred by friend or family member.Recently moved to the area.Internet Search.Social Media.Other
Are you bringing a guest?*

Yes, I am bringing a guest.No, I am not bringing a guest.
Guest's Name*

First NameLast Name
Will you need overnight accommodations for you and your guest on Saturday, February 15?*

Yes, and we will need VHF to pay.Yes, and we will be self-pay.No, we do not need overnight accommodations .
Saturday night accommodations will be provided at the Shalom Retreat House. Since you will be sharing a room with your guest the registration fee is $25 per person (total $50).*

Yes, I have read and we will pay $50 by February 7th .
Saturday night accommodations will be provided at the Shalom Retreat House. The room rate is $60 per person for shared occupancy (total $120).*

Yes, I have read and we will pay $120 by February 7th .
Will you need overnight accommodations on Saturday, February 15?*

Yes, and I will need VHF to pay.Yes, and I will be self-pay.No, I do not need overnight accommodations .
Saturday night accommodations will be provided at the Shalom Retreat House. Due to a limited number of rooms, we encourage attendees to consider sharing a room if possible. The registration fee is: $25 per person for shared occupancy; $40 per person for single occupancy.*

Yes, I am open to sharing a room and will pay $25 by February 7th.No, I would prefer to not share a room and will pay $40 by February 7th.
Saturday night accommodations will be provided at the Shalom Retreat House. Due to a limited number of rooms, we encourage attendees to consider sharing a room if possible. Since you are self-pay your registration fee is waived: The room rate is $60 per person for shared occupancy; $80 per person for single occupancy.*

Yes, I am open to sharing a room and will pay $60 by February 7th.No, I would prefer to not share a room and will pay $80 by February 7th.
Do you or anyone in your group have any dietary needs and/or restrictions that we should be made aware of? If so please list below, if the answer is "NO", write "N/A".*
Do you or anyone in your group have any mobility needs that will require assistance?*

YesNoMaybe
PHOTO RELEASE: I hereby authorize and permit the Virginia Hemophilia Foundation and its authorized agent to use my photograph, voice and/or likeness, with or without my name or the name of the person for whom I am the parent/guardian, in its sole discretion as it sees fit, free and clear of any claim whatsoever on my part, and without compensation.*

I have read and YES I agree.I have read and NO I do not agree.
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RSVP for VHF Women's Retreat Weekend

Attendee Information