Manitoba/Saskatchewan Patient Empowerment Meeting
The Canadian Fabry Association (CFA) is hosting a Patient Empowerment Workshop for patients living in Manitoba and Saskatchewan (only available for those who did not attend the Calgary Empowerment Meeting) - Please RSVP by October 10th, 2018.
DATE: October 27th, 2018
TIME: 9:00am – 3:30pm (Time subject to change)
LOCATION: Inn at the Forks
(Address: 75 Forks Market Rd, Winnipeg, MB R3C 0A2)
Accommodations will be covered for patients and their families if your commute to the Inn at the Forks is more than 2 hours, or if you are flying in for the Patient Empowerment Workshop.
A light breakfast, hot lunch, and afternoon break will be served throughout the workshop.
We will reimburse preapproved mileage, bus fare, train, and parking for qualified participants. For patients and families requiring flights, the CFA will arrange flights and will reimburse pre-approved transportation costs associated with getting to and from airports.
Deadline: October 10th, 2018
Thank you, we look forward to spending the day with you.
How many people, including yourself will be attending the Patient Empowerment Workshop?
Please list the names of all those attending in your family, please put a asterisk(*) ahead of the patient's name(s).
Please list your email address for you, and anyone you are registering.
Please click on the option that best describes you
Fabry patient & Family member to a Fabry patient
Physician/Nurse/Fabry Clinic/Healthcare Professional
What is the best number to reach you at?
Do you, or anyone in your party have accessibility or special accommodations? If yes, please include the individual's name.
Empower yourself with knowledge!
Will you be driving 2 hours or longer? Please copy and paste Google map mileage with application. The CFA will reimburse 35¢/km.
Will you require Hotel Accommodations? (Those travelling from more than 2 hours away may be eligible for an accommodation scholarship)If yes, please indicate how many people?
Do you, or any member of your family, have food allergies/intolerances we need to be mindful about? (If yes, please list the member's name and the allergy/intolerance). We will do our best to accommodate your needs.
Fill in the blank with a positive empowering word that describes you and anyone you are registering - I AM.... (for example: brave, fearless, courageous...resilient...etc...) . *Ensure you complete this for all members of your party joining you. They will be used on our name tags.
Do you have anything else about you or your family that you would like us to know?
Page 1 of 1
Never submit passwords through Google Forms.
This form was created inside of Canadian Fabry Association.