LHF Men's Retreat Registration Form

LHF Men's Retreat Registration Form

September 25 - 27, 2026. Our Men's Retreat is for Men (21 years and older) with a bleeding disorder and/or a caregiver, immediate family member. Please complete and submit to hold your spot.
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to person with bleeding disorder. (If you have a bleeding disorder please reply: self.)
Your age
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name
Emergency Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
LHF will reimburse mileage for those who live 50+ miles away from event facility. Will you need reimbursement?
LHF will provide a double room (shared with a room mate). Please indicate below if you wish to pay for your own single room that you will reserve on your own
The retreat is for Friday and Saturday nights. departing early Sunday. Please indicate which night you will be in attendance and will need a hotel room
In your shared room, roommates will be randomly assigned, unless you have a room mate request that you are listing below (if you are ok with a random assignment--please type in no specific roommate request)
LHF will be providing a round of golf on Saturday morning. Please indicate below if you would like to participate
Please indicate below if you have a golf handicap OR indicate how many rounds a year do you play golf.
Please indicate if you need LHF to rent golf clubs for you OR if you can bring your own
Please indicate if you have specific people you want to be on a foursome with for golf
Dietary Restrictions or Special Requirements
Liability Waiver: Assumption of the Risk and Waiver of Liability Relating to Illness/Injury/Accident. I, and on behalf of family members and minor children I am registering, voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself or any family members and minor children I am registering, (including, but not limited to, Illness, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my attendance at the LHF 2025 Men's Retreat, 7/18-20/2025, or participation in LHF programming (“Claims”). On behalf of myself and family members and minor children I am registering, hereby release, covenant not to sue, discharge, and hold harmless the Louisiana Hemophilia Foundation, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs, or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Louisiana Hemophilia Foundation, its employees, agents, and representatives, whether a illness or injury occurs before, during, or after participation in any LHF program. By typing my name below, I am agreeing to this statement with my electronic signature:
THE Louisiana Hemophilia Foundation (LHF) PHOTO RELEASE Consent:I hereby grant the LHF permission to use my likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration.I understand and agree that all photos will become the property of the LHF and will not be returned.I hereby irrevocably authorize the LHF to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.I hereby hold harmless, release, and forever discharge the LHF from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. I HAVE READ AND UNDERSTAND THE ABOVE PHOTO RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENTS/GUARDIANS AS EVIDENCED. By typing my name below, I am agreeing to this statement with my electronic signature:
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