Lupus Patient Education Class - Registration
Pick the Patient Education Classes you would like to register with. with the Lupus Foundation of Northern California. If you would like to register offline, please return to LFNC.org or call 408-954-8600.
I/we would like to attend the following class:
choose the class you want to sign up for.
First Name
Your answer
Last Name
Your answer
Email Address
Your answer
Phone:
Your answer
Gender
Address
Your answer
City, State, Zip
Your answer
LUPUS PATIENT INFORMATION (OPTIONAL)
Are you a lupus patient?
If not, please describe your relationship to Lupus.
Your answer
LUPUS CLASS INFORMATION
Will you be attending with someone else?
If yes, how many guests?
Your answer
Please list the names of the guests you will bring (additional participants):
Please list one name per line and optionally indicate whether each is a lupus patient.
Your answer
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