Exchange Registration - Sarcoma Alliance

October 3-4, 2020 - Virtual Event!

Attendee Information

Name:*

First Last

Type of Attendee*

Patient in Current/ Recent Treatment
Patient out of Treatment (focus on long-term effects)
Caregiver/Family Member

Sarcoma Subtype

I am willing to have my information included in a directory that will be distributed to all Exchange attendees. The information included will be: name, email, phone number, sarcoma subtype.

Company/Organization Name

(if applicable; applies to those attendees from sponsoring/exhibiting companies/organizations, medical institutions, etc. only)

Date of Birth

Date Format: MM/DD/YYYY

Phone*

Email*

We will send your confirmation and other applicable correspondence to this email address.

Confirm Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How did you hear about the Exchange?

Hospital/institution where you receive(d) your treatment

Terms and Conditions

Use of Personal Information: The personal information supplied in connection with this booking will be held by the Sarcoma Alliance as a record of attendees and parties expressing interest. By registering for this conference I agree that the Sarcoma Alliance may use that personal information to contact me by email, direct mail, telephone or fax to supply information relevant to this conference. Your information will not be shared outside of our organization unless you have opted in to being included in our directory as referenced above. Consent to Use of Image: Further, I grant permission to the Sarcoma Alliance to use my name, voice and images of myself in any photographs, motion pictures, publications or any other print, videographic or electronic recording of this event for legitimate purposes. *This program will be recorded and published online. Cancellations or Postponements: The Sarcoma Alliance may at any time, with or without giving notice, in its absolute discretion and without giving any reason, change, cancel or postpone the conference, change its venue or any of the other published particulars, or withdraw any invitation to attend. In any case, neither the Sarcoma Alliance nor any of its directors, officers, employees, agents, members or representatives shall be liable for any loss, liability, damage, costs, or losses incurred, such as any costs incurred, financial losses or expense suffered or incurred by any person, nor will they return any money paid to them in connection with the conference. Disclaimer of Medical Advice: Views expressed by speakers, sponsors and/or exhibitors are their own. The Sarcoma Alliance cannot accept liability for any advice given, or views expressed, by any speaker, sponsor and/or exhibitor at the conference or in any material provided to you. You understand and acknowledge that you are responsible for your own medical care, treatment, and oversight. All of the content provided on the Sarcoma Alliance website and at the conference is for informational purposes only and DOES NOT CONSTITUTE THE PROVIDING OF MEDICAL ADVICE and is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment. The content is not intended to establish a standard of care to be followed by you. You understand and acknowledge that you should always seek the advice of your physician or other qualified health provider with any questions or concerns you may have regarding your health. You also understand and acknowledge that you should never disregard or delay seeking medical advice relating to treatment or standard of care because of information contained in or transmitted at the conference. Changes to Terms and Conditions: We reserve the right at all time to change, amend, add or remove any of the above terms without prior notice. If one or more of the conditions outlined in these Terms & Conditions should be or become invalid, the remaining conditions will continue to be valid and apply. These Terms & Conditions apply to all participants of this event, including speakers, sponsors and exhibitors. Acknowledgment: By submitting this registration form, I acknowledge that I am the attendee and am 18 years of age or older, or that I am the parent or guardian for an attendee under the age of 18 and have the authority to register the minor and accept the terms and conditions on the minor’s behalf.

Acceptance*

By checking this box, I agree to the above stated terms and conditions. In additional, I agree to the use of my personal information by the Sarcoma Alliance to contact me by email, direct mail, telephone or fax, in order to supply information about this conference, other conferences, fundraising, events, and additional opportunities that the Sarcoma Alliance is planning and believes may be of interest to me.

I have read and accept the terms and conditions stated above.

Phone

This field is for validation purposes and should be left unchanged.