Ottawa Patient Support Group Meetings

Location and date of the Meeting or Event - Please check the meeting(s) for which you are registering *

Webinar - June 12, 2020Webinar - June 12, 2020

Patient Stories: Let's chat about AA and MDS - June 17, 2020Patient Stories: Let's chat about AA and MDS - June 17, 2020

Webinar - June 23, 2020

Ottawa Support Group MeetingsOttawa Support Group Meetings

AGM - October 17, 2020AGM - October 17, 2020

First Name

Last Name

Phone number

Email Address

Address

You are a

Diagnosis (if applicable)

Aplastic Anemia (AA)

Myelodysplasia (MDS)

Paroxysmal Nocturnal Hemoglobinuria (PNH)

OtherOther

Date of Diagnosis

We encourage sharing and networking at the meeting and can specify your disease type on your name tag to facilitate networking. Please indicate if you would like your disease type on your name tag

Yes

No

How did you hear about the meeting?

I would like to be added to the mailing list to receive updates, newsletters and other information

Yes

No

Do you have special dietary needs and/or food allergies?

Yes

No

If so, please indicate:

Volunteer

Clinical Trials

Patient Support

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