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GLHF Fun and Education Weekend Registration Form

Registration and payment due by May 14, 2009
 

Name:
Address:
Email:  Phone:

 

People in Your Party (first and last name) Bleeding
Disorder
Nanny
Requested
Name:          Age:  
Name:          Age:
Name:          Age:
Name:          Age:  
Name:          Age:  

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.


 Registration:

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 send GLHF a check by May 14, 2009

                         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.

   

Contact Us | Donate | Home  

Great Lakes Hemophilia Foundation

  638 N. 18th Street, Suite 108
Milwaukee, WI
53233
E-mail:
  info@glhf.org

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.