KD Parent Symposium September 25, 2010 - Registration
Please e-mail catherinefrank@kdfoundation.org with questions concerning registration process. For event questions please contact the UCSD KD lab at 858-246-0157 or adultkd@gmail.com.

First Name

 

Last Name

 

Address

 

City, State

 

ZIP Code

 

Country

 

Home Phone

 

Mobile Phone

 

Email

 

# of Adults Attending

 

Are you a parent of a child who has or had KD? Yes No

 

If so, what are their name(s)?

 

Babysitting Required? No Yes

 

** NOTE: This will be a group of high school volunteers providing babysitting service.

If so, how many children?

 

Also, what are their ages?

 

How did you find out about the UCSD symposium event?

 

To prove you are human, please enter the number between 3 and 5.

 

Any additional comments