Sickle Cell Disease Association of America, Inc. (SCDAA)
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SCDAA
231 East Baltimore Street
Suite 800
Baltimore, Maryland 21202

Office   410.528.1555
Fax   410.528.1495
Toll Free   800.421.8453

scdaa@sicklecelldisease.org
www.sicklecelldisease.org

 



Monday - Friday:
9:00am - 5:00pm (EST)

Annual SCDAA Convention
Get Involved with Sickle Cell Disease Association of America, Inc.
Annual Convention

Convention Registration 2013

Please Note:

Please use one form per registrant.

All registrants with Sickle Cell Disease must supply the following information to receive discount
(Parent/Spouse/Guardian must supply information if you are attending in place of person with the disease.)

Registration Packages
(One ticket for the SCDAA 41th Annual Gala included in Registration Fee)		 Members
EARLY
Ends 08.01.13
10% Discount		 Non-Members or (Non-Active)
EARLY
Ends 08.01.13		 Late Total
M.D. and Ph.D.
Nurse/Health Professional/Social Worker
SCDAA Member Organizations/ or Board Members
General Participant
Individuals with SCD/ Parent/ Students
(Must show student ID onsite)
One Day Registration
Sub-Total =
Additional Ticket Sales Price Quantity
SCDAA 41st Annual Gala $125.00 x =
Total =
DIETARY REQUIREMENTS
Other:
DISABILITY/ACCESSIBILITY REQUIREMENTS
Other:

PAYMENT INFORMATION - Full payment is due with Registration Form

REGISTER BY MAIL OR FAX:


Please make checks payable to:

Sickle Cell Disease Association of America, Inc. (SCDAA)
231 E. Baltimore St., Ste. 800 - Baltimore, MD 21202
410-528-1555 - Fax:410-528-1495
Toll Free: 1-800-421-8453


REGISTER BY CREDIT CARD:


Credit Card Billing Information




All individuals are responsible for booking their individual hotel and travel arrangements.

REFUND POLICY: August 01, 2013 deadline for cancellations. There will be NO REFUNDS after September 3, 2013. PLEASE NOTE: If you are unable to attend the conference and did not cancel your registration before the August 1, deadline, you are still responsible for payment of conference registration fees. You may send a substitute whose name must be submitted in writing to SCDAA by September 3, 2013.