JA Family Education Day 2014 Registration

Thank you for your interest in attending our fun and exciting JA Family Education Day at the Mill Valley Community Center on March 1st. Please fill out this online registration form and we will be in touch with you soon. If you have any questions, please contact Emma Davis at 415-356-5488 or edavis@arthritis.org.

* Was your child diagnosed within the last year (i.e. since January 2013)? This answer will be used to put you into the appropriate group for the Talk with Your Docs Session.
Do you want ALL of your children to be in the same children's breakout room? If so, your children will be placed in the room that corresponds with the age group that your child with arthritis should be in. Age groups are broken into ages 7 and under, ages 8-13, and ages 14-18. (Ex: If your child with arthritis is 9 years old, your other children will all be in the ages 8-13 room)
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* Do we have your permission to sign you up as an e-advocate? E-Advocates help improve the lives of people living with arthritis. The key to success in changing government policies and funding is through grassroots advocacy and our e-advocates are the Arthritis Foundation's chief resource for making positive changes in Washington. By signing up, you'll receive Action Alerts in your inbox when important arthritis-related issues are debated on Capitol Hill. In 5 minutes or less, you'll be able to write your elected officials and tell them their constituents care about arthritis and how it impacts our communities.
* In order to confirm your registration and family's attendance at JA Family Education Day this year, we ask that you pay a registration fee of $10 (See below if you are in need of a scholarship. You will still need to check the button below to move forward.).
* Please sign or initial the below Photo and Liability Release Clause:

I hereby grant the Arthritis Foundation, Great West Region specific permission to reproduce, publish, circulate, copyright, or otherwise use any and all photographs of me and/or my family, taken at this JA Program, for use by the Arthritis Foundation, Great West Region. I understand and agree that neither the Arthritis Foundation, Great West Region nor any co-sponsoring organization or facility, nor their respective chapter, officers, directors, employees, agents, members, or volunteers shall assume or have any responsibility or liability for expenses or medical treatment or for compensation for any injury I or my child/children may suffer or resulting from our participation in this program.
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* Indicates Response Required