APPLICATION for HFA's 2nd Mild Matters Summit

The Mild Matters Summit creates a safe space for females and males with mild bleeding disorders and parents of children with mild bleeding disorders to gather for education, engagement, and support.

Summit Objectives:

Increase knowledge/ awareness of mild bleeding disorders including signs and symptoms of bleeds and diagnostic measurements.
Discuss challenges of accessing diagnosis and treatment for people with mild bleeding disorders.
Introduce bleed tracking tools and spend time practicing their use.
Practice collaborating with HCPs for diagnosis and care through role playing.
Create and nurture social connections between people with mild bleeding disorders.
Discuss opportunities to advocate for people with mild bleeding disorders.

HFA's 2nd Mild Matters Summit will be held at POSTOAK Lodge & Retreat in Tulsa, OK from Nov 16-19, 2023. Participants will arrive before dinner on the 16th and fly home the morning of the 19th (breakfast will be provided). PostOak is located approximately 15-20 minutes from the Tulsa airport (TUL). Travel and lodging will be provided by HFA.

We appreciate your interest in the 2nd Mild Matters Summit. HFA will be choosing a limited number of applicants across the USA, ensuring diversity across a multitude of categories. Chosen attendees are expected to attend ALL sessions. Due to the demand for this event, we will not be able to accept everyone who applies. It is possible that only one family member will be chosen to attend if multiple apply.

Contact Info

Please enter your first and last name as it appears on your government-issued ID.

First Name:

Last Name:

Credentials: (optional)

Company/Organization: (optional)

Email:

Mobile Phone:

Note: Please provide phone that will be used during travel.

Your Gender Preference:

Birthdate:

Note: You must be at least 18 years of age by Nov 1, 2023 to attend.

Mailing Address

Country:

Street Address:

City:

State:

Zip Code:

Questions

Briefly share why you would like to attend the Mild Matters Summit.

(500 character limit)

What is the largest struggle you face with mild bleeding disorders?

(500 character limit)

What questions would you like answered for people with mild bleeding disorders?

(500 character limit)

Do you have a mild bleeding disorders success story to share? What is it? (please write "n/a" if you do not have one)

(500 character limit)

How will you share information learned with your local community?

(500 character limit)

Is there any additional information you would like to share with HFA regarding your application to attend the Mild Matters Summit?

(500 character limit)

HFA has received a record number of applications for attendance and would like to ask if applicants would be willing to share a room (with two beds) if chosen to attend.

If chosen to attend the Mild Matters Summit, the following is my room preference:

I will only attend MM if I have a single room.I am willing to share a room with another MM participant as assigned by HFA staff.I would prefer my own room, but am willing to share a room to accommodate more participants.

Adult with Disorder	Partner/Spouse of Someone with Disorder
Parent of Someone with Disorder	Child of a Parent with Disorder
Sibling of Someone with Disorder	Grandparent of Someone with Disorder
Other Family of Someone with Disorder	Government
Medical, Product, Pharmacy Provider	Bleeding disorder non-profit
Specialty Pharmacy	Pharmaceutical/Biotech
HTC

VIII (8)	IX (9)	von Willebrand (vWD)
vWD Type 1	vWD Type 2	vWD Type 3
I (fibrinogen)	II (prothrombin)	V (5)
VII (7)	X (10)	XI (11)
XIII (13)	Platelet Disorder	BD of Unknown Cause (BDUC)
Other