17th Annual Lowe Syndrome Conference Registration

June 24th-26th, 2022 in Dallas, TX!

Please register for the LSA 2022 conference! Registration deadline is May 20th, 2022.
A conference stipend may be available for first time conference attendees only. Inquire at info@lowesyndrome.org.
Note: There is a separate form for childcare registration. Please see link here.

LSA Conference Registration

"*" indicates required fields

General Information

Name*

First Last

Phone*

Address

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

Email*

Attendance Package*

Adults are considered age 16 and over. LSA boys of all ages are free.

How many adults are attending?*

Age 16 and above (do not include LSA boys)

Adult Attendee Information*

Please provide name, relation, and professional status (if applies) of each adult attending. Please add a row for each adult attending. This information will be used for name badges and conference directory listing.

Name

Relation to boy with LS (parent, etc.)

Professional Status (if applicable)

How many children are attending?*

Siblings (15 years and younger) and all boys/men with Lowe Syndrome

Child Attendee Information*

Please add a row for each child attending.

Child Name

Age

Does this Child have Lowe Syndrome?

Relation to boy with LS (sibling, etc.)

Will this child need childcare?

The LSA will be taking pictures throughout the conference. These pictures will be used on our website, newsletter and other publications. Do we have permission to use your picture and/or your family members for these purposes?

Yes

Would you be interested in volunteer activities for the LSA and/or Board of Directors?

Type of activity you are interested in:

What are you looking to benefit from at this years LSA conference?

Is this your first time attending a Lowe Syndrome conference?

Other comments

Total pricing for in person full conference

Price: $175.00

Total pricing for in person Saturday only

Price: $125.00

Price for virtual conference

Price:

Price

We are sad you are not able to attend! Thank you for donating. Please enter your custom donation amount below.

Product Name

Price: $0.00

Credit Card*

Card Details

Cardholder Name