SCDAA 2020 Convention Scholarship Application - International

SCDAA 2020 Convention Scholarship - International

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 the person with the disease.)

The cost for the Scholarship is $25. Once you are approved you will receive an email with a discount code to register.

*Please Note: These Scholarships are on a first come first serve basis and may be subject to denial.

REFUND POLICY: The deadline for cancellations and refund is September 30, 2020. There will be NO REFUNDS after September 30, 2020.

PLEASE NOTE: If you are unable to attend the conference and did not cancel your registration before the September 30th 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 on or before October 1, 2020 via email to nthomas@sicklecelldisease.org

Question Title

* 1. Contact Information

Name

City/Town

State/Province

Country

Email Address

Phone Number

Question Title

* 2. Are you an Individual with Sickle Cell Disease or a Caregiver

Individual with Sickle Cell Disease

Caregiver

Question Title

* 3. Name the provider who manages your sickle cell disease.

Question Title

* 4. Is the provider your Hematologist or Primary Care Physician

Hematologist

Primary Care Physician

Other (please specify)

SCDAA 2020 Convention Scholarship Application - International

SCDAA 2020 Convention Scholarship - International

Question Title

* 1. Contact Information

Question Title

* 2. Are you an Individual with Sickle Cell Disease or a Caregiver

Question Title

* 3. Name the provider who manages your sickle cell disease.

Question Title

* 4. Is the provider your Hematologist or Primary Care Physician

Question Title

* 5. Name your Health Care Facility, City and Country