27th Annual Family Education Weekend – Midwest Hemophilia Association

09/14/2019 - 09/15/2019

8:00 AM

Embassy Suites
10401 S. Ridgeview Rd, Olathe, KS, 66061

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Name
This field is for validation purposes and should be left unchanged.
Primary Registration Name*
First Last
Adult Name #2
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Childrens / Youth Activities
Name Age Child Care 0-5 years (not currently in Kindergarten) Youth Program K-5th Grade (currently in Kindergarten) Teen Program 6th-12th Grade Saturday Night Dave & Busters (Yes / No)

Please fill in the information for each person in your group that is under 18 years. To add more click the (+) plus button at the right.
Affected Bleeding Disorder
Hotel Accomodation?*
- I live at least 150 miles+ from the event and will need a room for Friday night. (cost covered by Chapter)
- I do not meet the 150+ miles, BUT I need a room Friday night (I am responsible for payment for Friday night)
- I need a room for Saturday night only (cost covered by chapter)
Please Select appropriate one.
First Time Attendee?
- First Time Attendees
If your are a first Time Attendee, the registration fees will be refunded when you check in at registration.
Family Education Weekend*
- $55 - Registration / Activity Fee
Total
$0.00

Name	Age	Child Care 0-5 years (not currently in Kindergarten)	Youth Program K-5th Grade (currently in Kindergarten)	Teen Program 6th-12th Grade	Saturday Night Dave & Busters (Yes / No)