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Hilton Garden Inn Conventions Center, New Orleans

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* 1. Full name and age/date of birth. (Must be 18+).

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* 2. Name and relationship to person with bleeding disorder.

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* 3. Full name and age (must be 18+) of spouse or Partner that you will be registering. Please choose only one.

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

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* 5. Please provide email address.

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* 6. Hotel accommodations will be provided by LHF for registered guests and one spouse or partner. Please check room type.

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

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* 8. Do you or your spouse/partner have any food allergies? If so please provide name and allergen.

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* 9. LHF will provide mileage reimbursement if you live 50+ miles away from the event location. Please provide your address if you would like to receive reimbursement .

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

Accident/Injury/Illness:

I, and on behalf of family members and minor children I am registering, voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself or any family members and minor children (If applicable) I am registering, (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 F 2025 Couple's Retreat, 9/12-14/2025, or participation in LHF programming (“Claims”). On behalf of myself and family members and minor children I am registering, 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 illness or injury occurs before, during, or after participation in any LHF program.

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* 11. Questions or comment? We welcome all!

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