Community Outreach Program : Factor Up

Join us for a hybrid educational dinner presentation Thursday, May 16, starting at 6:00pm at Ocean Zen in Springfield, Missouri OR online via Zoom.

Learn about the importance of Factor VIII levels and what a new treatment could mean for your management plan. Please RSVP by May 9th.

*A zoom link will be provided prior to the event via email for those attending online.

Factor Up Flyer

May 16th 2023 - Community Outreach Program

Adults Attending:*
Click the PLUS sign next to the box to add more. Diagnosis examples: Hemophilia A, Hemophilia B, von Willibrands, Carrier, Other, N/A
First Name Last Name Date of Birth Diagnosis
Kids attending:
Click the PLUS sign next to the box to add more. Diagnosis examples: Hemophilia A, Hemophilia B, von Willibrands, Carrier, Other, N/A
First Name Last Name Date of Birth Diagnosis
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email
How will you be attending?*
- I will attend in person
- I will attend online (A zoom link will be emailed to you prior to the event)
Are you employed by a specialty pharmacy or product manufacturer?*
- No, I am not employed by a specialty or product manufacturer. .
- Yes, I am employed by a specialty pharmacy or product manufacturer.
Photo Consent Opt Out -From time to time, the Midwest Hemophilia Association (MHA) will want to use pictures and/or videos from our events to promote bleeding disorder programs and MHA's activities. Please check the box below if you would NOT like to grant permission to be able to use your image or those who have registered for that purpose.
- No I do NOT consent to the use of pictures of videos.

Thank you to your program sponsors:

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Date
Date(s) - May 16 2023 at 6:00 PM - 8:00 PM

Location
Ocean Zen

Category(ies)

First Name	Last Name	Date of Birth	Diagnosis

First Name	Last Name	Date of Birth	Diagnosis