2021 Virtual Conference Registration - National Neutropenia Network

Today's Date

Name of person completing form*

First Last

Phone*

Email*

This email will receive the confirmation with links for the registered sessions.

Age of person with neutropenia*

Which type of neutropenia has been diagnosed?*

Please enter the names of each adult wanting to attend*

Please enter the name(s) and age(s) of each child you would like to attend

Please note: if you have a teenager that wished to attend the third option during breakout #1, Teen Only session, please provide a separate registration for the teen that is attending that session. Thank you.

Networking Sessions 12-12:50 PM ET (Pre-conference)

Medical Providers Only
Families with kids with Neutropenia
Adults with Neutropenia
Not attending

The networking sessions are for attendees to connect with others, typically done at our in-person conference. If you plan to attend one of the networking sessions, please choose one option from the list. If you are unable to attend or do not wish to attend, please leave blank as

Session(s) attending: 1pm-2:00pm ET*

Session 1: Update on SCNIR, COVID, & Treatments
Cannot Attend

Session(s) attending: 2:15pm-3:15pm*

Session 2: Genetics & How to talk to your doctor about diagnosis/resources/questions to ask
Cannot attend

Breakout Sessions 3:45pm- 4:45 pm

Infants & Neutropenia
Parents of school-age children
Teens ONLY: Quality of Life & Coping with Neutropenia
Adults: Living with Neutropenia
Cannot attend breakout session

Please choose one option from the list above. Please note: if a teen is attending the Teen only session, please have them complete a separate registration so they can attend the session.

Breakout Session 2, 5pm-6pm ET

Cyclic Neutropenia
Congenital Neutropenia
Idiopathic or Autoimmune Neutropenia Kids
.Idiopathic or Autoimmune Neutropenia Adults
Cannot attend breakout session

Please choose one option from the list above.

Hope to gain from the retreat

What do you hope to gain from the Neutropenia Retreat?

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retreat

2021 Neutropenia Virtual Conference Registration

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