Sponsor Registration

Sponsor Registration Form

The 2023 Annual Conference for the Federal Hemophilia Treatment Centers for Western States/Region IX will take place April 28-30, 2023, at the Westdrift in Manhattan Beach.

The Regional Coordinating Committee (Invitation only) will be on, Sunday, April 30, 2023.

Address: 1400 Parkview Ave, Manhattan Beach, CA 90266

Registration is required to attend.
Separate forms must be filled out for each attendee.
Please submit a completed registration form by March 17, 2023.

Prefix (Ms., Mrs., Mr., Mx., Dr., etc.)

Pronoun (She, He, They, etc.)

Name

First Last

Position / Title

Organization

Other: What is the name of your organization?

Phone

Is your organization participating in the Pharmacy Panel?

Yes

If yes, please indicate the name of the speaker.

Biographical Sketch (3-5 sentences). NOTE: Bio sketches, CV, and disclosure forms are only required for individuals participating in the pharmacy panel.

Accepted file types: pdf, doc, docx, Max. file size: 2 MB.

Disclosure Form

Accepted file types: pdf, doc, docx, Max. file size: 2 MB.

Please submit your presentation to Tran Le at tle@c3dibd.org by 4/11/2023.

Meals included will be Friday reception, Saturday breakfast, lunch, am/pm breaks, and dinner, and Sunday breakfast, lunch, and am break. Please list any FOOD REQUIREMENTS:

Food Allergies

HOTEL RESERVATION: The group rate of $199.00/night + applicable state and local taxes (currently 12% and CA Tourism Fee $0.44); Rates guaranteed through 3/17/2023.

Please indicate any questions/issues that you want addressed during the conference

Sponsor Registration Form

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