Clone of SCAGO Sickle Cell Summit 2025 Registration Form

Title
Full Name

First NameLast Name
Affiliation
E-mail
example@example.com
Country
Province/State
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Which Day do you plan to attend?
Select which applies, are you a:

Other
Do you require CME credits?
What is your Specialty?
What is the name of your organization?
Select your ticket and pay. Early bird special pricing from July 1st to 15th only! Special discount for patients and families: 50% off !, and for everyone else 25% off. *Discounted Pricing already applied*
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Patients & Families
50% off until July 15th

$10.00 CAD



Industry Partner
25% off until July 15th

$75.00 CAD



Physician
25% off until July 15th

$56.25 CAD



Nurses and Other Allied Health Professionals
25% off until July 15th

$37.50 CAD



Researcher
25% off until July 15th

$37.50 CAD



Student
25% off until July 15th

$15.00 CAD



Community Advocate
25% off until July 15th

$15.00 CAD



Total

$0.00 CAD

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty: