Online registration is closed but you can still register by calling Katie Bitner at 404-965-7538.
See you at the conference!

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec cursus ante sed tortor mollis tempus. Nullam lobortis, ante et volutpat rhoncus, augue lacus rutrum erat, in accumsan est lorem vel dui. Nulla facilisi. Sed arcu lectus, mattis non sollicitudin at, tincidunt vitae urna. Praesent tempor ornare laoreet. Phasellus magna lorem, volutpat et pellentesque commodo, blandit eget metus. Duis faucibus porttitor nunc at dapibus. Curabitur ac urna sed nunc ornare sodales. Phasellus viverra ante ut lectus mattis lacinia. Phasellus auctor volutpat porta. Aliquam erat volutpat. Cras arcu lectus, condimentum vitae viverra ut, condimentum quis ipsum. Pellentesque ac tellus mauris. Nam vestibulum purus lobortis urna molestie vehicula. Nulla semper dolor mi, non ultrices nibh. Curabitur euismod hendrerit sem id luctus. Cum sociis natoque penatibus et magnis dis parturient montes, nascetur ridiculus mus. Aliquam cursus lacinia urna at faucibus. Praesent et dolor eu dui convallis condimentum. Nunc vitae metus in sem porttitor pellentesque. Vivamus quis risus est, ac laoreet libero. Proin feugiat, velit in mattis aliquam, ipsum velit sollicitudin metus, a condimentum ipsum dolor nec purus. Cras quis lacus ut elit malesuada imperdiet. Vestibulum quis leo quis nunc rhoncus placerat. Morbi magna elit, consectetur eget tristique non, euismod non arcu. Quisque ac est a urna iaculis suscipit at vel odio. In metus nunc, scelerisque in imperdiet nec, consequat quis elit. Sed magna odio, tincidunt ac dictum ut, accumsan nec augue. Phasellus ac volutpat justo. Aliquam erat volutpat. Phasellus a rutrum ante. Duis elementum magna vitae erat volutpat nec rutrum ligula posuere. Sed mi purus, vestibulum ac tincidunt id, dapibus sed lacus.
Earlybird registrations must be received on or before June 28, 2010.
* required information
Individual & Family/Group Registration Form
 
SECTION 1: CONTACT INFORMATION
  • Enter your own information in this section. You will enter names of any additional attendees later.
  • If you don't know your Arthritis Foundation chapter affiliation requested below, find it here with your ZIP code (this link opens a new browser window).

NOTE: ALL REGISTRATIONS WILL BE LISTED BY FAMILY NAME.

First Name:*
Last Name:*
Name/Nickname to appear on badge:
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Email:*
Phone:*
Cell Phone:
Arthritis Foundation Region/Chapter Affiiliation:
Do you have arthritis?:* Yes
No
Prefer not to answer
What type of arthritis affects you the most?:
List meal restrictions and/or special needs:
Emergency Contact Name:*
Emergency Contact Phone:*
Would you like to receive a free subscription to the "Kids Get Arthritis Too" newsletter: Yes
No
May the Arthritis Foundation share your name with other organizations/sponsors?:* Yes
No

SECTION 2: REGISTRATION FEES
Tips for Family Registrations:
  • If you have 2 to 4 total attendees, including yourself, enter one (1) Family Registration.


  • If your group has more than 4 total attendees, enter one (1) next to Family Registration, and enter the number of additional attendees next to Additional Family Members.(Example: For 8 total attendees, enter 1 Family Registration, and enter 4 Additional Family Members.)
Individual Registration:
One attendee
Earlybird registration accepted on or before June 28: $100 per individual. (Fee increases to $150 after June 28).

@ $150.00 = $
Family Registration:
Up to 4 family members
Earlybird registration accepted on or before June 28: $175 per family. (Fee increases to $200 after June 28).

(No Charge)
Additional Family Member(s):
More than 4 attendees
Earlybird registration accepted on or before June 28: $20 for each additional family member. (Fee increases to $25 per additional family member after after June 28).

(No Charge)

SECTION 3: ADDITIONAL DONATION (Optional)
Would you like to take this opportunity to make an additional donation to the Arthritis Foundation?
Amount:$

SECTION 4: ADDITIONAL INFORMATION
Is this your first Juvenile Arthritis Conference?: Yes
No
I/we plan to attend (check all that apply): Parent Breakout Sessions
Young Adult/Transition Sessions (youths transitioning to adult JA)
Your story has power! How has arthritis affected you and your family?:
Would you like information about treatments from Juvenile Arthritis Corporate Sponsors?: Yes
No

By submitting this form, you automatically agree to the following: PHOTO AND LIABILITY RELEASE CLAUSE: I hereby grant the Arthritis Foundation and its representatives, employees, and agents, the irrevocable and unrestricted right to use, reproduce and publish photographs, video and or audio of me, including my image and likeness as depicted therein, for the world wide web, social networking sites, editorial, broadcast or any other purpose and in any manner and medium; to alter the same without restriction; to copyright the same; and waive any rights of compensation or ownership thereto. I hereby release the Arthritis Foundation and its trustees, officers, employees, agents, legal representatives and assigns from any and all claims, actions and liability relating to its use of said material. I understand and agree that neither the Arthritis Foundation nor any co-sponsoring organization or facility, nor their respective chapters, officers, directors, employees, agents, members, or volunteers shall assume or have any responsibility or liability for expenses or medical treatment or for compensation for any injury I or my child/children may suffer during or resulting from our participation in this program.