Thank you for your interest in attending One Rare Experience 2021: Self-Care. Please fill out this survey to apply for registration.   

Please note, official registration closed on July 15th however we welcome persons that want to attend the sessions to still apply - unfortunately we will not be able to ship anyone who registered after July 15th a care package.  


One Rare Experience 2021: Self-Care
Virtual Zoom Event

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* 1. One Rare Experience is for people 35 years of age and younger, living with a rare disease indicate yes or no if you meet this criteria.

If you are willing to share your age with One Rare at this time, please indicate in the box below.

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* 2. Would you like to attend One Rare Experience 2021: Self-Care?

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* 3. Do you have access to a device that is able to utilize Zoom platform, Google Chrome browser (free download) and a connection to the internet (e.g. WIFI or wired)?

Note:  One Rare does not want technological barriers to limit participation - we will reach out to you if you indicate 'no' to this question.

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* 4. Your contact info:

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* 5. Please indicate which days/times you are available to attend? (Select all that apply.)

Note:  Registration is limited and One Rare will give preference to participants with the most availability as we want each participant to get the most out of entire program.

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* 6. This year's One Rare Experience theme is Self-Care. 

Please indicate which events/topics you are interested in attending?  (Select all that apply.)

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* 7. Are there any events/topics you would like to see added to this or future One Rare Experience programs?

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* 8. Can you accept a care package (includes giveaways and any supplies needed for scheduled events)?

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* 9. Do you have any dietary restrictions? (Select all that apply.)

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* 10. Is Uber Eats available in your area?  If not, can you specify if there is a meal delivery service in your area (e.g. Grub Hub, Door Dash, Seamless, etc).

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* 11. There will be opportunities for pictures, screen shots or quotes to be used in social media platforms promoting One Rare organization and/or events.  

If you are selected to participate in this year's One Rare Experience, do you give consent for use of your likeness (image) or quotes by One Rare and the #RareIs team?

(Example:  click on link to see a screen shot captured from last year's event on One Rare's home page).

Please let us know if you have any questions or comments in the field below.

For any questions, please email info@onerare.org and we will respond as soon as possible.  Thank you! 
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