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GLHF Fun and Education Weekend Registration Form Registration and payment due by May 14, 2009
Name: Address: Email: Phone:
Is this your first time attending the conference? Yes No If yes, would you like to be connected to a mentor family? yes no
Number Attending Saturday Dinner at Kalahari #Adults # Children.
Nonrefundable Room Fee ($60 for each room you require)
$
Guest rooms with more than 4 people add $20
Registration fee (nonrefundable $25 per family)
A nonrefundable registration fee of $50 is due per individual who is not an immediate family member (parent, non-adult sibling, spouse, significant other) and will be attending the conference.
Total for non-family members ($50 per person)
**The actual value of the weekend per family is $550 TOTAL
For reservations on Friday evening, June 12th, (stay at your expense-$89) call the Kalahari Resort to make your reservations, 608-254-5466, and indicate the GLHF Conference.
Method of Payment:
I will pay online with a Visa or Mastercard - Please make note of your total After you submit this form click the Pay Online Now button.
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Great Lakes Hemophilia Foundation
Phone: (414) 257-0200 Toll free: (888) 797-4543 Fax: (414) 257-1225
Copyright © 1999, Great Lakes Hemophilia Foundation. All rights reserved. Last updated Monday August 30, 2010.