CLF-LV RSVP 2017

The Cutaneous Lymphoma Foundation invites you to join us at our Las Vegas Patient Networking event.

Location: St. Rose Dominican Hospital - San Martin Campus
Address: 8280 W. Warm Springs Rd, Alijian Conference Room B - Las Vegas, NV 89113

Schedule:
Monthly Meetings - 2nd Wednesday of the month, 6:00 pm - 7:00 pm

To RSVP, please fill out the following survey and submit. If you have provided the Foundation with your mailing and email addresses when registering for past CLF-LV events, feel free to skip those questions unless your information has changed.

2. Contact Information:

First Name *This question is required.

Last Name *This question is required.

Street Address

City

State

Postal Code

Email Address

Home Phone

May we share your contact information with the group leader/s? *This question is required.

Mobile Phone

Guest Name

Relationship

3. Will you be attending the CLF-LV group meeting? (Response Required) *This question is required.

Yes, I will be attending.
No, I am unable to attend.

4. Do you give the CLF permission to use any pictures of you that may be taken with our group? Photos may be used for CLF's printed publications, website or Facebook page and individuals may or may not be identified. (Response Required)
*This question is required.

5. If you are not able to attend this event, would you be interested in future patient networking events?

Yes, please notify me of future events.
No, I am not interested in patient networking events.

6. Comments:

7. Would you like to receive our e-newsletter to keep up on our news, updates, and tips?

Yes, send me news and updates. (We respect your privacy and will not send unsolicited email.)

CLF-LV RSVP 2017

CLF-LV Patient Networking Event