Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you need to register an additional adult? *

Yes

No

Do you need to register an individual living with AS? *

Yes

No

Do you need to register a second individual living with AS? *

Yes

No

Do you need to register any children? *

Please indicate if any children (without AS diagnosis) will be in attendance:

Yes

No

Will you be attending the Family Dinner on July 16th? *

Yes

No

Is this your first Family Conference? *

Yes

No

Terms and Conditions *

By completing this registration, you acknowledge and agree to the following terms: (1) I confirm that a caregiver (18+ years old) is registered to attend the full conference and understands their role and responsibilities as a care provider at the ASF Canada Family Conference. (2) I acknowledge and agree that all attendees waive, release, and forever discharge any and all rights, actions, and claims against the Angelman Syndrome Foundation Canada (ASFC), its officers, directors, staff, volunteers, representatives, successors, and assigns for any injury, loss, or damages sustained in connection with participation in this event. (3) The views and opinions expressed by speakers and exhibitors at the conference are their own and do not necessarily reflect those of ASFC. ASFC assumes no responsibility for the application or use of the information presented. (4) In the event that ASF is unable to hold the conference due to unforeseen circumstances that make it inadvisable, illegal, or impossible to provide the facilities or proceed with the event, ASF Canada is not responsible for any costs incurred by registrants in connection with the conference.

By checking this box, I confirm that I have read and agree to the above Terms & Conditions.