Registration Form

Name(s):__________________________________________________________________________

Child(ren) and age(s): ________________________________________________________________

                                _________________________________________________________________

                                _________________________________________________________________

Mailing Address:_____________________________________________________

City, State, Zip: _____________________________________________________

Phone: _________________________ e-mail: ____________________________________________
 

I/We are interested in attending a national meeting/conference.  Yes m    No m

I/We would like to volunteer/help with:
    m Ideas (for gatherings, newsletters, etc.)
    m Providing Manpower (greetings, signs, finding info, etc.)
    m Board of Directors
    m Planning
    m Committees

Please mail completed form to:

Snake River Hemophilia and Bleeding Disorders Association, Inc.
P.O. Box 203
Newdale, ID 83436

OR

email the information to chad@srhbda.org