RSVP for Richmond Days

RSVP for Richmond Days

Monday, January 26, 2026
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.
Please Provide Your Current Physical Address: You must list your HOME ADDRESS to ensure we contact the appropriate representatives. You must include your ZIP CODE + 4-DIGIT extension (Example: 12345-6789) to ensure we correctly identify your congressional district.

Look up your 4-digit zip code extention HERE.
Physical Address (NO P.O. Box)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please Let Us Know How You Heard About This Event.*

Referred by HTC.Referred by other healthcare provider.Referred by friend or family member.Recently moved to the area.Internet Search.Social Media.Referred by HACA.Other
How many people (including yourself) will be attending?*

12345
GUEST INFO: Please type the first and last name, age, and their relationship to you. If you do not have anyone to add please type "N/A"*
Will you need overnight accomodations on Sunday, January 25?*

Yes, and I will need VHF/HACA to pay.Yes, and I will be self-pay.No, I do not need overnight accomodations.
Do you or anyone in your group require an ADA compliant room? If the answer is "NO", write "N/A".*
Are you interested in joining VHF/HACA for an educational dinner on Sunday, January 25?*

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
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.
Should be Empty:

RSVP for Richmond Days

Attendee Information