2013 Family Building Conference Registration

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To register for the 3rd Annual Family Building Conference on Saturday, April 27, 2013, from 8:30 a.m. to 12:30 p.m., please complete the registration form below. The 2013 conference will be at Penn Valley Community College. Go to our 2013 Conference tab on our website to receive the address and driving directions. We look forward to meeting new faces and seeing others again! If you have any questions, please email us at kcinfertilityawareness@hotmail.com.

VERY IMPORTANT: If you will attend with others, EACH person must register separately. Thanks!

***KCIA respects your privacy and will not share your personal information with outside sources.***

Last Name *

First Name *

Street Address

City *

State *

Zip Code *

Email Address #1 *

If you would like to receive emails to more than one email address, please type into box(es) below.

Email Address #2

Email Address #3

Phone Number

Please include area code.

Breakout Session Choice #1 *

You may only choose one. All sessions will be video recorded and uploaded onto our website if there's more than one you like below.

In-Vitro Fertilitzation & Beyond

Recurrent Miscarriage/Mind-Body Therapy Program

Medical, Social, & Legal Aspects of Embryo Adoption

Breakout Session Choice #2 *

You may only choose one. All sessions will be video recorded and uploaded onto our website if there's more than one you like below.

Evaluation of the Male Partner

Opportunities for Adoption

Faith & Infertility

Would you and your significant other be interested in being interviwed for a news story?

In years past, local news stations have asked to interview couples who will attend the upcoming conference. These may either take place at a residence or in studio.

Yes, we'd love to!

No, thank you.

Clear selection

How did you learn about the 2013 Conference? *

Please be specific because this info helps us learn the best ways to spread the word (attended prior conference, Facebook, Twitter, from family or friend, internet, doctor, counselor, etc.). If from a specific doctor, please give name.

Why are you attending the 2013 conference? *

Please check all that apply. This info helps us learn the best way to support you.

I am interested in learning more about infertility treatments (IUI, IVF, etc.)

I am interested in learning more about adoption (domestic, international, private).

I am interested in learning more about embryo adoption.

I am interested in learning more about male infertility.

I am interested in learning more about recurrent miscarriage.

I am interested in learning more about faith and infertility.

I am looking for a reproductive endocrinologist.

I am looking for an adoption agency.

I am attending to offer support to my loved one who is struggling to build a family.

Other:

Required

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