Registration Form

Conference Registration open until August 1, 2024.

Don’t forget to book your hotel at our discounted rate!

 

  • Attendee Information

  • Below please provide the names (and ages, if under 18) of all attendees in your group/family (including yourself) and meal attendance.
    NameAge (if a minor)Patient, family member, friend or industryGaucher Type or Gaucher Type of Loved OneDietary Needs 
  • Sunday dinner, Monday lunch, Monday dinner, Tuesday lunch, Tuesday dinner. Please type “All” if you will be in attendance for every meal.
  • Industry Representatives and Providers/Researchers

  • NameCompanyEmail 
  • Releases and Waivers

  • GCA will take photos of attendees throughout the conference. These photos are for GCA use only and may appear on the GCA Website, newsletter, 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.
  • 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 associated with infection of COVID-19 or complications, symptoms, or other effects resulting from contracting COVID-19. 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 DUE TO COVID-19 OR OTHER ILLNESSES, 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.