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2019 Family Conference Registration

 
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Indicate all of the events that you will be attending

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DINNER CHOICES:
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PHOTO/VIDEO RELEASE

Please read carefully our photo/video release form and accept or decline. If declining, your family will be unable to participate in any group or individual photos/videos taken at conference. Your registration tag will note "No Pictures" and you may be asked to sit where you won't inadvertently be included in pictures or videos.

I hereby give permission to NBIA Disorders Association to use and distribute (not limited to use in newsletters, guides, brochures, videos, appeals, Web site and reports) at their discretion, any photographs or videos taken at the Tenth International NBIA Disorders Association Family Conference, of which I, my friends, or a member of my family may be a part. This release includes all individuals under this family registration.

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WAIVER AND ASSUMPTION OF RISK (FOR CHILD by parents/legal guardians)

I/We are the parent(s) or legal guardian(s) of named individuals, a minor (hereinafter “Child”). Parent voluntarily makes and grants this Waiver and Assumption of Risk in favor of NBIA Disorders Association. including but not limited to employees, contractors, volunteers, agents and all others engaged in efforts on behalf of or at the direction of the aforementioned entity as consideration for Child’s opportunity to use the facilities, equipment, materials and participate in the activities, events, festivities and/or gatherings sponsored by and part of the NBIA Disorders Association family conference; Parent hereby waives and releases any and all claims whether in contract or of personal injury, bodily injury, property damage, damages, losses and/or death that may arise from Child’s aforementioned use or participation, as I understand and recognize that there are certain risks, dangers and perils connected with such use and/or participation, which I hereby acknowledge have been fully explained to me and which I fully understand, and which I accept, assume and undertake after inquiry and investigation of extent, duration, and completeness wholly satisfactory and acceptable to me. I further agree to use my best judgment in permitting Child to engage in these activities, and to fully explain to Child and require compliance with all safety instructions and recommendations, whether oral or written. I hereby certify that I am a competent adult, executing this Waiver of my own free will, being under no compulsion or duress. This Waiver and Assumption of Risk is effective from May 30, 2019 to June 2, 2019 inclusive, and may not be revoked, altered, amended, rescinded or voided without the express prior written consent of NBIA Disorders Association.

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If you have anyone on your registration form who will be in the Care Room, a Care Room Information Form must be filled out and sent to pwood@NBIAdisorders.org before your registration is complete.
 

WAIVER AND ASSUMPTION OF RISK (FOR ADULT IN CARE ROOM by legal guardian)

I/We voluntarily make and grant this Waiver and Assumption of Risk in favor of NBIA Disorders Association, including but not limited to employees, contractors, volunteers, agents and all others engaged in efforts on behalf of or at the direction of the aforementioned entity as consideration for the opportunity to use the facilities, equipment, materials and participate in the activities, events, festivities and/or gatherings sponsored by and part of the NBIA Disorders Association Family Conference; I/We hereby waive and release any and all claims whether in contract or of personal injury, bodily injury, property damage, damages, losses and/or death that may arise from my aforementioned use or participation, as I/We understand and recognize that there are certain risks, dangers and perils connected with such use and/or participation, which I hereby acknowledge have been fully explained to me and which I fully understand, and which I accept, assume and undertake after inquiry and investigation of extent, duration, and completeness wholly satisfactory and acceptable to me. I/We further agree to use my best judgment in undertaking in these activities, and will faithfully adhere to all safety instructions and recommendations, whether oral or written. I hereby certify that I am a competent adult, executing this Waiver of my own free will, being under no compulsion or duress. This Waiver and Assumption of Risk is effective from May 30, 2019 to June 2, 2019, inclusive, and may not be revoked, altered, amended, rescinded or voided without the express prior written consent of NBIA Disorders Association.

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If you have anyone on your registration form who will be in the Care Room, a Care Room Information Form must be filled out and sent to pwood@NBIAdisorders.org before your registration is complete.
 













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More Information about Attendees (if applicable):
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Conference T-Shirt Design


The NBIA Disorders Association logo is on the back of the T-Shirt.


































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0.00 USD
 
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When you click the button below you will be taken to the secure payment page. You can choose a way to pay. You may Pay with a Debit or Credit Card or Pay with your PayPal Account. You do not need to have a PayPal account or create a PayPal account in order to pay securely online.

2019 Conference Menu

Click the buttons below for more information about the NBIA Family Conference.

Conference Homepage

Conference Program

Hotel Info & Reservations

Mentor Program Information

Care Room Information Form

Charleston, SC Photos

Donate to the Scholarship Fund

Become a Sponsor


While at the conference, use the following hashtags in your social media posts:

#shinealightonNBIA

#NBIA2019Conference

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