Patient Advocacy Conference

Gaucher Community Alliance
Patient Advocacy Conference
Registration Form

Please join us in Austin, TX for our first Patient Conference!

Sunday, November 7, 2021

  • 6-8pm: Welcome reception/registration and casual buffet dinner for patients and families to meet.

Monday, November 8, 2021

  • 8-9 am: Breakfast
  • 9am – 5pm All day breakout workshops for only patients and families; Lunch will be provided.
  • 2pm – 5pm: Industry sponsor booths open.
  • 7pm: Dinner for patients, families, industry sponsors and providers/researchers

Tuesday, November 9, 2021

  • 8am – 9am: Breakfast
  • 9am – 4pm Industry sponsor and provider presentations on research, prospective treatments, and trials; Lunch will be provided.
  • 12pm – 4pm: Industry sponsor booths open
  • 4pm: Conference wraps up in the afternoon.

Hotel detail:

Courtyard Marriott Austin Downtown, 300 E 4th St, Austin, TX 78701

Reservation link to be provided shortly.

Full agenda to follow shortly.

Scholarships are available to attend the conference in the amount of $650 for one person or $850 for both patient and caregiver. Priority for scholarships are given to workshop facilitators and are then awarded on a first come, first serve basis and will be paid after conference attendance. Please click here to complete a scholarship application.

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.

Meals
Meals
Meals

INDUSTRY REPRESENTATIVES AND PROVIDERS/RESEARCHERS: GCA will send information about the required industry registration fee. Please provide the requested information below.

Meals
Meals

Safety Precautions: For the safety of all attendees, including our children and immunocompromised members of our community, we ask that you and your eligible family members be completely vaccinated when you attend the conference. If you are not vaccinated, please plan to wear a mask at all indoor activities.

Waiver of Liability and Indemnity Related to COVID-19 Warning

GAUCHER COMMUNITY ALLIANCE has taken enhanced health and safety measures—for you, other attendees, exhibitors, and staff. You must follow all posted instructions while visiting GAUCHER COMMUNITY ALLIANCE events and activities. An inherent risk of exposure to COVID-19 exists in any public place where people are present. COVID-19 is an extremely contagious disease that can lead to severe illness and death. I acknowledge that participation in GAUCHER COMMUNITY ALLIANCE events and activities brings some risk and I do hereby assume responsibility for my own well-being. I will follow all Centers for Disease Control and Prevention (CDC) guidance, and all posted instructions while visiting GAUCHER COMMUNITY ALLIANCE events and activities. I understand, agree and hereby consent that my failure or disregard to follow all protocols in effect and required by GAUCHER COMMUNITY ALLIANCE, CDC, the venue provider and governing authorities during my attendance at GAUCHER COMMUNITY ALLIANCE International is hereby sufficient grounds to be excluded from attending the event by GAUCHER COMMUNITY ALLIANCE or an event authority, and I hereby consent in advance to leave and exit the event, without protest or refund, upon request by GAUCHER COMMUNITY ALLIANCE or an event authority due to my refusal to follow said protocols.

Assumption of Risk

I have read and understand the above warning concerning COVID-19. I hereby choose to accept the risk of contracting COVID-19 for myself in order to attend a GAUCHER COMMUNITY ALLIANCE conference and enter into the conference premises. The conference is of such value to me that I accept the risk of being exposed to, contracting, and/or spreading COVID-19 in order to attend in person.

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 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, 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 Texas 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.

Do you agree to the waiver above?*
Have you received your COVID-19 Vaccination?*
Are you willing to have a Rapid Test upon arrival at the conference if you are not vaccinated?*

Sponsers

Premier Sponser:

Gold Sponser:

Friendship Sponsers:

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