Join us for the Spina Bifida Conference in Corpus Christi, TX

Driscoll Children's Hosptial
Corpus Christi, TX
Saturday, April 29, 2017
8:30AM-4:30PM
 
 
 

Conference Registration

Please fill out all applicable information. NOTE: You will be redirected to this page once submitted and must must then click payment button to complete your registration.

Name*

Spouse if attending

Classification

Parent
Adult w/SB
Caregiver
Professional

Type of Caregiver/Professional if applicable

Title (for caregiver/professional)

Employer(for caregiver/professiona)

Daytime Telephone*

Email Address*

Street Address*

City*

State*

Zip Code*

Caregiver/Professional-Go to Submit Button

The following section is for sb families only.

Sponsorship:

Yes, I would like to be considered for financial aid (SB Families only).
Yes, I will be traveling over 75 miles and would like to receive a travel discount (Discount of $25 per family).

Friday Evening

SBTX will host a Meet and Mingle. Children are welcome.

Will attend
Will not attend

Please note: Childcare will be provided.

Please register children who will be in childcare. If you have more than 3 children please contact SBTX at 210-826-7289.

First Child's Name

First Child's Age

Second Child's Name

Second Child's Age

Third Child's Name

Third Child's Age

Please enter the phrase above

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Lunch provided by Hope Medical

 

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