Hemophilia of North Carolina

Hemophilia of North Carolina

Since 1977, in service to the people of North Carolina
affected by bleeding disorders

PO Box 70, Cary, NC 27512 — 1-800-990-5557 (toll free)

HNC Legislative Day

Tuesday, June 10, 2008
Raleigh, NC

 Legislative Day
Event Registion  

   First  Last
 (*) Name:
 (*) Address:
 (*) City:  (*) State:  (*) Zip:
 Home ph:  Cell ph:
 (*) Email:
 Number  Attending:   (*) Adults:    Children: 
 (*) Indicates required information
   Indicate hotel room needs (HNC member individuals and families):
  Smoking: Yes No No preference
  Wheelchair Accessible: Yes No No preference
  Bed(s): Double (2 beds)
Bed(s): King (1 bed)
Bed(s): M — with cot? Yes No — (for rooms with King bed only)
  Other:

When you click on "Send Registration" above, your information will be sent by email to HNC at info@hemophilia-nc.org. In a few days HNC staff will send a confirmation to the email address you specified above. Hemophilia of North Carolina will never share, give or sell your name, address or health-related information to any other organization, company or individual without your express permission.

If you prefer, you may download a printable registration form* and return the completed form by mail or fax.

Return to the 2008 HNC Legislative Day information page.

(*Adobe Acrobat Reader is required.)