Gaucher Albany Advocacy Day Registration
April 27-28, 2026
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Email *
Primary Contact *
Phone number *
Address *
City *
State *
Zip Code *
Below please provide the names (and ages, if under 18) of all attendees in your group/family and meal attendance. Please note any dietary needs or restrictions (i.e. kosher, vegetarian, etc.) in the space provided.

Names (to be printed on tag)
*
Patient, family member, or friend *
Dietary needs *
Attending the following meals:  *
Required
GCA will be reserving hotel rooms for Monday, April 27th in Albany. A dinner and training session will begin at 5:30pm on Monday, April 27th. Do you need a hotel room? *
Do you need any accommodations for the hotel room or for the advocacy day? Please describe the accommodations that would make attendance possible.

Cost to Attend:

GCA will reimburse travel costs to Albany associated with the advocacy day. Travel costs (train, mileage, parking) will be reimbursed following attendance at the day. Hotel accommodations and meals will be paid for by GCA. 

I understand that travel reimbursement will be paid after the advocacy day. I am responsible for arranging travel to attend the advocacy day and accepting the hotel of GCA's choice , Hampton Inn Albany. GCA has no obligation for payment of any direct expenses. I further understand that by accepting travel funds I am committing to attend the full day of advocacy in Albany.

*
Required

Photo Release: 

GCA will take photos of attendees throughout the program. These photos are for GCA use only and may appear on the GCA Website, newsletters, conference brochures, social media outlets, or other future GCA promotional material. By virtue of your attendance, you agree to usage of your likeness in such media.

Waiver, Release, and Indemnification

As a condition of my participation in this meeting or event, I, do hereby expressly waive any rights against and release and hold harmless GAUCHER COMMUNITY ALLIANCE and any of its officers, employees, affiliates, contractors, agents, heirs, legal successors, and assigns (collectively “GAUCHER COMMUNITY ALLIANCE'') from and against any and all claims, suits, demands, losses, damages, expenses, or liability of whatever kind or nature (collectively “liability”), under any theory of law or equity, that may arise during or as a result of my presence at the premises, including but not limited to any such liability related to or arising out of illness, injury, or death. I shall defend, indemnify, and hold harmless GAUCHER COMMUNITY ALLIANCE and all other Releases against any and all losses, damages, liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties, fines, costs, or expenses of whatever kind, including attorney fees, fees and the costs of enforcing any right to indemnification under this Agreement, and the cost of pursuing any insurance providers, arising out or resulting from any claim of a third party related to the Activities.

I UNDERSTAND, AND IT IS MY EXPRESS INTENT, THAT THIS RELEASE AND WAIVER OF LIABILITY RELEASES GAUCHER COMMUNITY ALLIANCE FROM SUCH LIABILITY EVEN IF SUCH LIABILITY RESULTS FROM OR IS CAUSED BY THE SOLE OR CONTRIBUTORY OR ACTIVE OR PASSIVE NEGLIGENCE, STRICT LIABILITY, OR OTHER LEGAL FAULT OF GAUCHER COMMUNITY ALLIANCE OR ANY THIRD PARTY. I ALSO UNDERSTAND AND AGREE THAT GAUCHER COMMUNITY ALLIANCE DOES NOT ASSUME ANY RESPONSIBILITY OR OBLIGATION TO PROVIDE FINANCIAL OR OTHER ASSISTANCE, INCLUDING BUT NOT LIMITED TO MEDICAL, HEALTH, OR DISABILITY ASSISTANCE IN THE EVENT OF INJURY OR ILLNESS. IN THE EVENT THAT I OR MY FAMILY MEMBER IS INJURED, BECOMES ILL, OR SUFFERS COMPLICATIONS, ALLEGEDLY AS A RESULT OF MY PARTICIPATION IN A GAUCHER COMMUNITY ALLIANCE EVENT, I AGREE TO RELEASE AND HOLD HARMLESS GAUCHER COMMUNITY ALLIANCE IN THE SAME MANNER AND TO THE SAME EXTENT AS SET FORTH ABOVE.

Choice of Law and Venue

I understand and agree that the law of the State of Pennsylvania will apply to this contract and the Venue for any legal action.

BY COMPLETING THE REGISTRATION FOR THIS EVENT, I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS RELEASE AND FREELY AND KNOWINGLY ASSUME THE RISK AND WAIVE MY RIGHTS CONCERNING LIABILITY AS DESCRIBED ABOVE.


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A copy of your responses will be emailed to the address you provided.
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