CSRF and AIU 2023 Patient Conference Meeting Registration

THIS REGISTRATION FORM IS FOR THOSE WHO HAVE CUSHING'S AS THEIR PRIMARY AFFILIATION. Adrenal Insufficiency United has a separate registration form available here if your AI was not related to Cushing's - https://united4rare.org/registration/

The full conference for both AIU and CSRF will take place Thursday - Saturday March 30-April 1. All adult attendees will be required to sign a Waiver of Liability and Indemnity Related to COVID-19. Parents/guardians will sign on behalf of their dependent(s).
Registration is free and includes lunch on Friday and Saturday. The hotel provides free daily breakfast and afternoon drinks and snacks.
Thanks to our sponsors we are able to offer a reduced hotel rate of $150 per night. Free childcare (Kidscamp) is available for kids ages 5-12.
This initial registration form is intended to capture your intent and give you the information you need to book travel. We will follow up within the next few weeks to confirm all registrations and present additional options depending on your answers to some of the questions below.
Once the full Breakout Session Topic List has been finalized, you will also have the opportunity to sign up for your top choices and be confirmed for those sessions ahead of the conference.

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* 1. Full name of person responsible for registration

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* 2. Email address (if you have tight security controls on your email account, please add leslie@csrf.net to your safe list!)

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* 3. Phone Number

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* 4. Your City and State or Country

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* 5. Please indicate your affiliation(s) with Cushing's:

I am a patient currently pursuing a diagnosis.

I am a diagnosed patient.

I am the parent of a patient with Cushing's.

I am the spouse, friend, and/or loved one of a person with Cushing's.

I am a caregiver.

I am a professional interested in learning more about this disease.

I am a confirmed or pending vendor or sponsor of this event.

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* 6. Our program begins at 2:00pm on Thursday, March 30 2023 and ends in the late afternoon on Saturday, April 1 2023. Will you book lodging through us at the host hotel for the subsidized rate of $150 per night?

I don't need lodging or I will be staying elsewhere.

I do need lodging and I will definitely book through CSRF for the $150 rate.

I'm still thinking about it and will let you know later.

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* 7. If you will book lodging through CSRF (or think it's probable that you will), please let us know which nights you will likely book.

If you're traveling to Portland from the East, consider the time change going back and that most flights leaving Portland have connections, and many that leave after 2:00pm or so are going to get in after midnight or be red-eyes.

Wednesday March 29

Thursday March 30

Friday March 31

Saturday April 1

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* 8. If you will book lodging through CSRF (or think it's probable that you will), which room type would you prefer?

one King bed

two Queen beds

Extra Room Requirements?

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* 9. If you are staying at the hotel, would you be interested in sharing a double room with another attendee to share costs? (we will be in touch with more information if you answer yes)

Yes

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* 10. Child care for ages 5-12 is offered at no cost during the conference and you are welcome to bring a Caregiver, Spouse, Friend, or other guest. Please describe your likely party size:

Patients

Caregivers

Spouse / Friend / Family 18+

Children who will take advantage of the free child care (please indicate ages)

Older children (under 18) who will not need child care but may be interested in teen programming

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* 11. There are a couple of opportunities for small group dinner discussions and topics for conversation are endless. There may also be opportunities to participate in on-site advocacy board meetings or focus groups based on certain patient diagnosis information; these are usually compensated. Are you interested?

I'm interested in a casual setting group discussion that will probably involve a meal ("Brainstorming Dinner with CSRF", "Share your Patient Journey" Listening Session with Affiliate).

I'm interested in hearing more about any qualified studies (advocacy board meeting, focus group, usually include compensation) for which I might be a good fit.

I'd like to discuss a particular topic during a lunch and would like help setting up a table to invite others to join me.

I'm interested in any social activity that might be put together for Wednesday night with other Cushing's patients.

I'm interested in any social activity that might be put together for Thursday night with other Cushing's patients.

I'm interested in attending a pay-my-own-way dinner Saturday night with other Cushing's patients after the conference concludes.

No thanks!

Comments or Questions on this Item?

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* 12. Do you have any food allergies or restrictions we need to accommodate?

Yes

If yes, please elaborate here.

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* 13. We have been able to offer travel stipends at previous meetings but many aspects of planning and carrying out this conference are new or shared, so we need to collect a few weeks' registration information before knowing what we might be able to do. Financial assistance is not guaranteed but we will do whatever we can to make something happen.

Please drag the slider below to show us where you fall on the scale of needing financial assistance to attend the conference, with 100 representing the highest need.

I do not need financial assistance to attend.

Even one night's hotel covered would make a really big difference.

Absolutely will not be able to attend without significant financial assistance (50% or more of total travel and lodging expense)

Clear

i We adjusted the number you entered based on the slider’s scale.