STXBP1 Family Meeting Registration
Join us on 21 & 22 June 2019 in Philadelphia, PA!

Event website at http://stxbp1disorders.org/sifm2019/.

Questions? Contact us at info@stxbp1disorders.org

Email address *
First Name *
Your answer
Last Name *
Your answer
Phone Number
Your answer
If the above number is a mobile phone, can conference updates be sent via text?
Additional adult attendees
In the Family Conference session room we can only accommodate up to two parents and one additional caregiver per family, due to space constraints. If you need to request an exception, please provide an explanation below.
Names of additional adult attendees
Your answer
STX'er attendees
The STXBP1 Foundation is encouraging families to bring their STX'ers to build community, as well as facilitate participation in research studies and sample collection.

During the family conference sessions, there will be an adjacent room for STX'ers. Families are strongly encouraged to plan for their own caregiver, but the STXBP1 Foundation is working to secure a limited number of caregivers for STX'ers. Ideally we will find skilled volunteers, but there may be a cost for care. We will follow up with families who request care below.

Our STX'er is attending *
STX'er Name
Your answer
STX'er age (if <1 year, include "months" in your response, e.g. "6 months")
Your answer
If possible, we would like childcare for our STX'er
Tell us more about your STX'er and any special requirements that should be considered (mobility, meds, etc.).
Your answer
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