2022 SBAGNE Conference Registration

Friday, November 4 - Saturday, November 5, 2022

Hilton Hotel, Nashua NH

Registration Deadline October 28, 2022

Contact Information

Name *

Prefix

First Name

Last Name

Suffix

Address *

Address Line 1

Address Line 2

City

State

State/Province

ZIP/Postal Code

Email *

Verify Email *

Cell Phone *

I am *

An adult with Spina Bifida

A parent of a child with Spina Bifida

A parent or caretaker of an adult with Spina Bifida

A medical provider

A sponsor

A grantor

A supporter of the organization

Child's Name

Birthdate

(mm/dd/yyyy)

Babysitting

Babysitting will be provided for children ages birth - 5th grade. Please provide the names(s) and ages(s) of children requiring babysitting.

Name(s) and age(s) of children requiring Babysitting

Teen Programming

Teen programming will be provided for children grades 6-12. Please provide the name(s) and age(s) of children for teen programming.

Name(s) and age(s) of children for Teen Programming

Dietary Restrictions / Allergies

Does anyone in your party require/have dietary restrictions or allergies? Please describe below.

Dietary restrictions or allergies?

Accommodations Needed

Does anyone in your party require reasonable accommodation - e.g. translation/ASL services? Please describe below.

Accommodations needed

Photo Release

I agree that SBAGNE may use photos of me and/or my minor children from Conference for website, email. Annual Report and social media purposes.

Photo Release *

Yes

Conference Registration Fee

Registration Fee *

$25 - Single

$50 - Double

$75 - Family

$0 - I need to apply for a scholarship

Sponsor a Person or Family

If you would like sponsor a Conference Scholarship for a Person ($25), a Double ($50) or Family ($75), please visit our Donation Page and select Scholarship from the Type of Donation Dropdown.

Hotel Reservations

Hotel reservations are separate from the Conference Registration Fee. Click here to book your hotel reservations.

Add 3% to my total amount to help cover the payment processing fees