Sickle Cell Disease Association of America, Inc. (SCDAA)
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Convention

Annual Convention

Convention Registration 2016

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.)

 

Please enter member code to receive discount

Registration Packages
(One ticket for the SCDAA 44th Annual Gala included in Registration Fee)
Members
10% Discount
Non-Members - Early Bird
Ends 8.12.2016
"Prices subject to change after this date

Total

M.D. and Ph.D.
Nurse/Health Professional/Social Worker
SCDAA Member Organizations/ or Board Members
General Participant
Patient/Family/Student Registration Packages
(Does not include gala ticket)
(Must show student ID onsite)
Individuals with SCD
Family Member / Students
One Day Registration
Sub-Total =
Additional Ticket Sales Quantity
General Gala Ticket ($125.00)
Patient / Family / Student Gala Ticket ($50.00)

Total =

DISABILITY/ACCESSIBILITY REQUIREMENTS
Other:


PAYMENT INFORMATION - Full payment is due with Registration Form


Credit Card

Check or Money Order

Please make checks payable to:

Sickle Cell Disease Association of America, Inc. (SCDAA)
3700 Koppers Street, Ste. 570 - Baltimore, MD 21227

Please list your Member Organization Affiliation:

We will contact you within three days after registration to arrange payment

Credit Card Billing Information




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

REFUND POLICY: The deadline for cancellations and refund is September 1, 2016. There will be NO REFUNDS after September 6, 2016. PLEASE NOTE: If you are unable to attend the conference and did not cancel your registration before the September 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 6, 2016.



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