2023 NEUTROPENIA FAMILY RETREAT Join us at the Graduate Hotel in Cincinnati, Ohio July 14th – July 16th. Presenting Sponsor Supporting Sponsors Ella Jewell Foundation 2023 Retreat Registration "*" indicates required fields Today's Date MM slash DD slash YYYY National Neutropenia Network 2023 Family Retreat: Friday, July 14 - Sunday, July 16 in Cincinnati, OhioThe neutropenic community may be small as a rare disease, but together we are one big family! Whether you come alone or with others - all are welcome. We do our best to structure the weekend so that all can enjoy. From presentations and 1:1 consultations by medical professionals; small groups with peers; and Kids Camp for 4-16 year olds (whether they are neutropenic children, their siblings or the children of neutropenics). About Kids Camp. We believe neutropenia affects the whole family, which is why we offer Kids Camp - provided under the professional direction of Kristin McGuinness, owner of Sparklicious, her staff and volunteers. Kids Camp is for neutropenic children, their siblings and children of neutropenics. Please note, Kids Camp age groups are 4-9 and 10-16 for select activities. There will be plenty of activities where age groups are combined. If you have a 17-year-old traveling with you, we will contact you to determine how they can best experience the retreat. Please note that children under the age of four will not have an organized program to attend nor childcare available. In the past, families have chosen to bring additional family members to assist with childcare in order to attend sessions. Registration includes all presentations, handouts, children and teen programs (ages 4-16), tee shirts, Friday dinner reception, Saturday breakfast/lunch/dinner reception, and Sunday breakfast. Outside food and beverage cannot be brought into the event spaces. The retreat will be held at The Graduate Cincinnati. You will book your hotel room(s) separately at The Graduate Cincinnati. Our group discount provides rooms with two queen beds at $159 per night (plus taxes and fees). Maximum occupancy per room is 4 people. Group rate is available July 13 - 17 for those who wish to arrive early or stay late. Group rate available until June 19, 2023. Central Reservations Phone Number: 844-888-4723 Group rate code 7985377 www.graduatehotels.com Information of person completing the formIf attending with others, the person completing this form will be the NNN's primary contact. The person completing this form does not have to be the individual with Neutropenia.Name* Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. Prefix First Last AgePlease enter a number from 0 to 99.Shirt Type* Adult Youth Shirt Size* Small Medium Large XL Other Dietary Restrictions* Vegetarian Vegan Gluten-free Dairy-free None Other Relationship to Neutropenia?* I have Neutropenia My child has Neutropenia Traveling with an adult with Neutropenia Other Type of Neutropenia* Severe Congenital Cyclic Autoimmune Idiopathic Unknown Other Are you in need of a 1:1 consultation with doctor?*If you select yes or maybe, you will need to complete that form separately. Please refer to the link on the main page after you submit your registration. Yes No Maybe The NNN would like to make sure we address as many questions or concerns as we can. Please use this space to give topics of interest.What do you hope to gain from this experience?Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Enter Email Confirm Email What is the best phone number to reach you?*This phone number is*MobileLandlineIf there are others in your party, add their information belowPerson #2 First Last Neutropenic? Yes No AgePlease enter a number from 0 to 99.Shirt TypeUnisex Adult Youth Shirt Size Small Medium Large XL Other Dietary Restrictions Vegetarian Vegan Gluten-free Dairy-free Other Person #3 First Last Neutropenic? Yes No AgePlease enter a number from 0 to 99.Shirt TypeUnisex Adult Youth Shirt Size Small Medium Large XL Other Dietary Restrictions Vegetarian Vegan Gluten-free Dairy-free Other Person #4 First Last Neutropenic? Yes No AgePlease enter a number from 0 to 99.Shirt TypeUnisex Adult Youth Shirt Size Small Medium Large XL Other Dietary Restrictions Vegetarian Vegan Gluten-free Dairy-free Other Person #5 First Last Neutropenic? Yes No AgePlease enter a number from 0 to 99.Shirt TypeUnisex Adult Youth Shirt Size Small Medium Large XL Other Dietary Restrictions Vegetarian Vegan Gluten-free Dairy-free Other Person #6 First Last Neutropenic? Yes No AgePlease enter a number from 0 to 99.Shirt TypeUnisex Adult Youth Shirt Size Small Medium Large XL Other Dietary Restrictions Vegetarian Vegan Gluten-free Dairy-free Other Additional details you need to share about your group?Any additional details you need to share can be provided here. (If there are more than seven people in your party, provide their information here).Media Release*By selecting Yes, you authorize the NNN to use (without payment) any photographs, sound and/or video recordings of your party for public relations purposes. Yes No Registration Fees & PaymentRegistration includes all presentations, handouts, children and teen programs age 4-16, tee shirts, Friday reception (dinner), Saturday breakfast, lunch and dinner reception, and Sunday breakfast. You will book your hotel room(s) separately at The Graduate Cincinnati. Our group discount provides rooms with two queen beds at $159 per night (plus taxes and fees). Maximum occupancy per room is 4 people. Central Reservations Phone Number: 844-888-4723 Group rate code 7985377Adult (12 and up)*Price will increase to $180 on May 1, 2023 Price: $155.00 Quantity: Child 6-11Children 5 and under are free! Price: $95.00 Quantity: Would you like to provide an additional donation to the NNN?If yes, enter an amount here. This donation will appear on your registration confirmation, which can be used as a tax receipt as National Neutropenia Network is a 501(c)(3) nonprofit organization. Registration Fee Total CAPTCHA Please enter a description Book Your Room(s) Apply for a Hardship Grant Instead Request a 1×1 Consultation Request Hardship Discount Instead