TO BE RESCHEDULED…

Registration is now OPEN!

The following registration is for individuals attending an OHF Mom's Group activity facilitated by Beth Stallings. Meet and relax with mom friends who really understand.

Each adult attending should fill out their own form.

Please join us for a dinner and conversation:

Who: Mom's impacted by bleeding disorders

When: Thursday November 14, 2019

Time: TBD

Where: OKC

Address: TBD

Thanks for our sponsors:

Select Event

Name

First Name

Last Name

Age

What type of Bleeding Disorder is in your family?

Write NA if not applicable.

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email Address

Requests or Comments

Add extra attendees here in addition to special requests or comments.

Photo Release

I grant to the Oklahoma Hemophilia Foundation (OHF), its representatives and employees the right to take photographs of me and my property in connection with the above-identified subject. I authorize OHF, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that OHF may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. I have read and understand the above: