Community Member Registration for Annual Meeting

Community Member Registration for Annual Meeting

Friday, March 14 - Sunday, March 16, 2025
The VHF Annual Meeting is designed for VHF constituents and their immediate family and/or household members.

VHF Behavior and Program Registration Guidelines: Please read VHF's Behavior and Program Registration Guidelines before filling out event registration. 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/family member?*

YesNo
Guest/Family Member #1*

First NameLast Name
Age of Guest/Family Member #1 *
*IF OVER 18 WRITE N/A*
Are you adding another guest/family member?*

YesNo
Guest/Family Member #2*

First NameLast Name
Age of Guest/Family Member #2*
*IF OVER 18 WRITE N/A*
Are you adding another guest/family member?*

YesNo
Guest/Family Member #3*

First NameLast Name
Age of Guest/Family Member #3*
*IF OVER 18 WRITE N/A*
Are you adding another guest/family member?*

YesNo
Guest/Family Member #4*

First NameLast Name
Age of Guest/Family Member #4*
*IF OVER 18 WRITE N/A*
Are you adding another guest/family member?*

YesNo
Guest/Family Member #5*

First NameLast Name
Age of Guest/Family Member #5*
*IF OVER 18 WRITE N/A*
Will you need overnight accomodations on Friday, March 14th?*

Yes, and I will need VHF to pay.Yes, and I will be self-pay.No, I do not need overnight accomodations.
Will you need overnight accomodations on Saturday, March 15th?*

Yes, and I will need VHF to pay.Yes, and I will be self-pay.No, I do not need overnight accomodations.
Are you planning to attend the educational dinner on Friday, March 14th?*

Yes.No.Maybe.
Are you planning to attend the educational dinner on Saturday, March 15th?*

Yes.No.Maybe.
Are you planning to attend the 50th Anniversary Celebration on Sunday, March 16th?*

Yes.No.Maybe.
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
Do you or anyone in your group require an ADA compliant room? If the answer is "NO", write "N/A".*
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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Community Member Registration for Annual Meeting

Attendee Information