2008 National Family Conference: Educate, Inspire & Connect
Conference Registration Form
Chicago Marriott O’Hare - Chicago, Illinois
Friday, June 27 - Sunday, June 29
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| REGISTRATION DEADLINE: June 6, 2008. Required fields are in bold. |
| Contact Information |
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| Registrant Information |
| This section must be completed with registrant’s complete name, age, and type of ichthyosis (if appropriate). There are four tracks of programs: Adult (age 18+), Teen (ages 14-17), Tween (ages 11-13), and Child (ages 1-10). Based upon ages provided, each registrant will be assigned to the appropriate program.
*The Foundation has hired a professional child care company to entertain and supervise children, ages 1-10, while parents/guardians are participating in the adult program. There is a nominal, one-time fee of $15 per child to guarantee placement in the program and to hire the appropriate number of caregivers for the safety of your children. |
| Clinical Screening |
| Meet with expert dermatologists who are extremely knowledgeable about ichthyosis to answer any questions or concerns that you may have. These 15-minute appointments will take place throughout the day on Friday, June 27, from 9:00 am - 5:30 pm. You will receive an email prior to the conference with your appointment time. Please note: There may be physician residents intraining observing during your appointment. This will help educate future leaders in dermatology about ichthyosis.
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| Volunteering |
| Please check if you would be willing to volunteer with:
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| F.I.R.S.T. Idols Talent Sign-Up (Ages 5-18) |
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Performances will take place on Saturday evening at 8:00 pm. A compact disk player and microphone will be provided. You must bring your own music, costume, props, etc. All performances will be limited to a maximum of 2 minutes. |
| Photo and Video Permission Release |
| I hereby give my permission to F.I.R.S.T. to use and distribute including but not limited to use in newsletters, guides, documentaries, appeals, website and reports at their discretion any photos or video tapes taken at the 2008 Family Conference in which I or my family may be a part.
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| Payment |
In consideration of the acceptance of this registration entry, I/we the undersigned, assume full responsibility for any injury or accident which may occur while I/we am/are attending this conference. I/we hereby release and hold harmless the sponsors, promoters, and all other persons and entities associated with this event from any and all personal injury or damage, whether it be caused by the negligence of the sponsors, promoters or other persons or entity. Applications for minors will be accepted only if signed by a parent or guardian.
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