2019 CHI Family Conference Philadelphia

Registration 

Quantity
Price
Total
Registration fee for adults and teens (13 and up):
X
$
50.00=
$
0

Registration fee for families (2 or more adults and teens)
X
$
100.00=
$
0

Final Total:
$
0

Registration for children under the age of 12 is free.

Number of children under the age of 12 attending:
Babysitting needed during conference hours?
  • Yes
  • No
Additional names and ages of any family members attending:
Attending Friday Night Reception?*
  • Yes
  • No
Attending Saturday Night Dinner?*
  • Yes
  • No
Menu preference
  • Regular menu
  • Vegetarian
  • Gluten Free
Your Connection to CHI
  • HI Family
  • Person with HI
  • HI Specialist (Non-Ped Endos)
  • Other Medical
  • Industry
  • HI Specialist (Current Ped Endo)

Contact Information

Country*
State / Province*
Address*
City*
*
*
*
*
*
*
Email*
Confirm Email*
Phone*

Payment Information

Amount*
$
Name on Card*
Card Number*
Additional Comments

Security Code

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