Action Awareness Day"
Friday, June 19, 2020
Intercontinental Hotel, Los Angeles
Please complete this registration form and the payment page. Your registration will be acknowledged by email. THANK YOU!
(REGISTER BY JUNE 5 TO AVOID ADDITIONAL $50 CHARGE)
Please check off which events you will attend:
I am a neuropathy patient or caretaker and will attend the Event & Luncheon: $25 per person
I am NOT a neuropathy patient or caretaker and will attend the Event & Luncheon: $125 per person
I cannot attend in person but will watch on the Internet via Live Stream: Free
Please provide the information below:
(Type as you wish your name to appear in print)
Company / Organization
In addition, the following guests will attend:
Guest(s) of neuropathy patient/caretaker: $25
Guest(s) of non-neuropathy patient/caretaker: $150
I would like to make a contribution in the amount of:
Click "Continue" below to review your order and payment options.
: You may cancel or change your registration up to 7 days prior to the meeting
(on or before June 12)
without penalty. You will receive a full refund promptly. Cancellations for any reason received after
cannot be refunded. No shows are not refundable.
Please call or email us at (877) 512-7262 (
) for assistance. Thank you.