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WM Ireland Meeting - Saturday 22 March
WM Ireland Meeting Registration - Saturday 22 March
Register now for the first-ever Face to Face Ireland Support Group Meeting in Dublin on 22 March.
1.
First name
2.
Last name
3.
Email address
4.
Mobile Phone
5.
Do you have any allergies or dietary requirements we should be made aware of?
No nuts
No lactose
No gluten
No fish
Celiac
Vegan
Vegetarian
Pescatarian
Kosher
Halal
6.
Please provide an emergency contact phone number:
7.
To help us plan the networking groups, may we ask, are you:
A person living with Waldenstroms?
A care partner?
A healthcare professional / researcher
Other
8.
Photo, Audio, & Video Consent
Please confirm if you consent to be photographed, filmed, and/or otherwise recorded and to the release, publication, exhibition, or reproduction of all recorded media of your appearance, voice, and name for any purpose whatsoever in perpetuity in connection with the WM Ireland group and its partner organisations, programs and events, including, by way of example only, in social media, news and advertising.
Please let us know if you any concerns you may have about this policy.
By checking this box I agree to the photo, audio, and video policy
9.
Privacy Statement
By completing this form you agree that the data collected through this questionnaire will be used by the WM Ireland for the purposes of organizing this event, in collaboration with IWMF.
We are committed to safeguarding your personal information and will only collect, use, and share data in accordance with the GDPR.
Your data in relation to the event will only be held for a maximum of 12-months following the date of the event. You may withdraw your consent at any time by contacting us.
By checking this box, I consent for my data to be used as outlined.