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Annual Meeting Registration
Deadline 11/17/2025

Doubletree
1521 W Pinhook Road, Lafayette, LA 70503

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* 1. Full name and Bleeding Disorder (if applicable) of adults in your family that you will be registering. At least one family member must have a bleeding disorder to attend. LHF will provide one hotel room per family.

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* 2. Full name, age, and bleeding disorder, if applicable, of all children ages 3-6 that will be attending our childcare services. Child must be potty trained.

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* 3. Full name, age, bleeding disorder, if applicable, of all youth ages 7-17 that will be attending our youth activities and sessions.

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* 4. Indirect family members or friends of those affected by a bleeding disorder may attend at a cost of $225 for up to two adults for the full weekend. (invoice will be sent to registered email address)

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* 5. Phone number that you can be reached at during the day?

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* 6. Please provide email address.

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* 7. Hotel accommodations will be provided by LHF for registered patient guest only and their spouse/caretaker/support person and child(ren). One room per family. Please check room type.

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* 8. Will you be staying both Friday and Saturday night in hotel accommodations?

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* 9. Do you or any of your family members have a food allergy? If so please list names and food allergens below.

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* 10. Assumption of the Risk and Waiver of Liability Relating to

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my attendance at the LHF Annual Meeting, 11/21-23/2025, or participation in LHF programming (“Claims”). On behalf of my child(ren) and myself, I hereby release, covenant not to sue, discharge, and hold harmless the Louisiana Hemophilia Foundation, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs, or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Louisiana Hemophilia Foundation, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any LHF program.

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* 11. Accident/Injury Liability Waiver

I, the undersigned, being aware of my own health, limitations, and physical condition, acknowledge that I am voluntarily participating in the LHF Annual Meeting, 11/10-12/2023.

Having such knowledge, I understand that I am solely responsible for my personal safety and hereby release LHF, its representatives, agents, and event site host from liability for any accidental injury that may result from participation in this program.

I also accept this liability on behalf of my child(ren), and furthermore agree to supervise adequately to prevent injury.

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* 12. THE Louisiana Hemophilia Foundation (LHF) PHOTO RELEASE Consent:

I hereby grant the LHF permission to use my likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration.

I understand and agree that all photos will become the property of the LHF and will not be returned.

I hereby irrevocably authorize the LHF to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.

I hereby hold harmless, release, and forever discharge the LHF from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I HAVE READ AND UNDERSTAND THE ABOVE PHOTO RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENTS/GUARDIANS AS EVIDENCED

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* 13. Conference Conduct Policy
To ensure a respectful and inclusive environment for all participants, discussion of religion or politics is not permitted during this conference or its related activities. By checking yes, you agree to uphold this policy and contribute to a positive, welcoming atmosphere for everyone.

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* 14. Questions or comment? We welcome all!

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