Conference Registration - 2010 Conference Registration
National Alopecia Areata Foundation
14 Mitchell Boulevard
San Rafael, CA 94903
 Phone: 415.472.3780
Fax: 415.472.5343
 Email:
* Required information
Name: *
Age: *       # of Conferences Attended:    
Address: *
City: *
State: *       Zip Code: *
Country:
Phone: *
E-mail: *
Arriving
(day, date, time): *
Departing
(day, date, time): *
Will you be staying at the Hyatt Regency Hotel?
  Yes No
If not, where will you be staying?
 
Will you be part of the NAAF group rate at the hotel? (Only NAAF conferees will get the special room rate.)
  Yes No
You are responsible for making your own hotel reservations by calling or (800) 233-1234. Don’t Delay! Be sure to say you are part of the National Alopecia Areata Foundation group to get your special room rate. Reservations are limited, and are on a first-come, first-served basis. Reservations must by made by June 1, 2010.
Confirmation #
Names of additional persons sharing room:
 
REGISTRATION IS FIRST-COME, FIRST-SERVED
ATTENDANCE WILL BE DENIED OUT OF NECESSITY ONCE MEETING ROOM CAPACITY IS REACHED.
There is a registration fee of $195 for the first person. Accompanying spouse, family, friends and students (ages 5 - 17) are $155 each.
  # of People Per Person Fee Totals
Registration received by May 20 (first person) # $195 $
Accompanying spouses, family, and friends # $155 $
Children ages 5 to 17 # $155 $
Children pre-K or younger # COMP $
Indianapolis Indians Baseball Game Ticket # $10 $
Tortoise & Hair Walk/Run ($10 per person or $50 max per family.)
   Form will calculate $50 total even if your quantity is greater than 5.		 # $10 / $50 $
Scholarship Fund Donation (optional, but greatly appreciated) $ ← Enter in left box $
GRAND TOTAL     $
NAAF reserves the right to use any photograph taken at the NAAF conference, unless othewise notified. Registration for children attending the Children’s Conference Camp must include two signed permission forms: the NAAF Parent Permission & Responsibility Form and the Corporate Kids Events Emergency Consent, Release, and Rules & Regulations Form.
If you require special assistance to fully participate, please describe your needs below.
 

We need this detailed information to determine room size, name tags, and schedules. Only registered guests are allowed to attend sessions. Please complete this sheet carefully and thoroughly. Thank you.
  1. Enter the name and age of each person attending the conference. Names are to be written as you would like them to appear on a name tag.
  2. Check the box next to the events each person will attend (numbers in column correspond to the number of the names you entered in step 1). Adults please use the letter codes for your preferred Support Sessions (see page 10 of the brochure PDF for detailed descriptions.)
  3. For each child who attends the children’s camp, a Parent Permission & Responsibility Form and an Emergency Consent, Release, and Rule & Regulations Form must be submitted. Download/print them here, complete and mail or fax to NAAF. Registration is not complete unless we have received the forms.
Please list names, ages, and previous conferences of other family members who are attending, including children 4 and under.
# Name Age Grade # of
Conferences
Attended		 Has alopecia areata?
1 Yes No
2 Yes No
3 Yes No
4 Yes No
5 Yes No
6 Yes No
 
Thursday, June 24, 2010
 
2:00 pm - 5:00 pm Kids Camp (Ages 5-10)
2:00 pm - 5:00 pmTweens Camp (Ages 11-13)
2:00 pm - 5:00 pmTeens Camp (Ages 14-17)
3:00 pm - 5:00 pmYoung Adult Meet & Greet (Ages 18-24)
6:00 pm - 11:00 pmIndianapolis Indians Baseball Game - separate fee required - see cost above
 
Friday, June 25, 2010
 
8:30 am - 7:30 pm Kids Camp (Ages 5-10) - (Lunch & Dinner Provided)
8:30 am - 7:30 pmTweens Camp (Ages 11-13) - (Lunch & Dinner Provided)
8:30 am - 7:30 pmTeens Camp (Ages 14-17) - (Lunch & Dinner Provided)
9:00 am - 10:00 amChild Development Workshop
10:15 am - 11:00 amOrientation Workshop
11:15 am - 12:15 pmOpening Session
12:15 pm - 1:30 pmSupport Session Facilitators Lunch
2:00 pm - 3:30 pmSupport Sessions - See Program Explanations below
3:30 pm - 4:30 pmMeet the Exhibitors (Light Snack Provided)
5:30 pm - 7:00 pmAdult Welcome Reception (Light Snacks and No-host Cash Bar)
 
Saturday, June 26, 2010
 
7:30 am - 10:30 amTortoise & Hair Run/Walk
10:45 am - 3:30 pm Kids Camp (Ages 5-10) - (Lunch Provided)
10:45 am - 3:30 pmTweens Camp (Ages 11-13) - (Lunch Provided)
10:45 am - 3:30 pmTeens Camp (Ages 14-17) - (Lunch Provided)
11:00 am - 12:30 pmGeneral Session
1:30 pm - 3:30 pmAsk the Experts
4:00 pm - 5:00 pmDisco Bingo
8:00 pm - midnightDessert Dance Party with no-host cash bar (all ages)
 
Sunday, June 27, 2010
 
9:00 am - 11:15 am Kids Camp (Ages 5-10)
9:00 am - 11:15 amTweens Camp (Ages 11-13)
9:00 am - 11:15 amTeens Camp (Ages 14-17)
9:30 am - 11:00 amSupport Sessions - See Program Explanations below
11:45 am - 1:00 pmClosing Session (all ages)
1:00 pm - 2:00 pmGoodbye Gathering (Light Snacks and No-host Cash Bar)
 
NAAF Volunteers - Together Everyone Achieves More (TEAM)
 

Are you available to join the NAAF T.E.A.M. of volunteers? Please indicate what times and days you are available, i.e. not attending sessions, and which type of volunteer work you prefer. Thank you for volunteering. You'll receive a schedule in June if your schedule works with our needs.

Hospitality Person: Welcome conferees and answer their questions throughout the weekend.

Room Assistant: Assist in meeting rooms as door monitor, light monitor, materials distributor, etc.

Available on (days) and at (times)

 
      


If you are planning to stay at the Hyatt Regency Hotel, please have your confirmation number ready before registering online.

Thank you —

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