Conference Registration - Canadian Virtual Conference
Location
Please select...
Canada Virtual Conference
Number of Attendees
Please select...
1
2
3
4
5
6
First Name
Last Name
Email
Mobile Phone
Mailing Street
Mailing City
Mailing State/Province
Mailing Zip/Postal Code
Mailing Country
Individual Associated with BBS
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Myself
N/A
My Child
Other family member
Non-family
Name of Individual Associated with BBS
Age of Individual Associated with BBS
BBS Gene
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BBS1
BBS2
BBS3
BBS4
BBS5
BBS6
BBS7
BBS8
BBS9
BBS10
BBS11
BBS12
Other
N/A
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Sex of Individual Associated with BBS
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Male
Female
Major Medical Issues
Current Level of Vision
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No significant vision loss
Significant vision loss
Legally blind
Blind
If 18+ are they Independent?
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Yes
No
Please elaborate on the level of independence
Medical specialists the person sees regularly.
How big of an issue is appetite or weight management?
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Not an issue
Controlled
Controlled but problematic
Uncontrolled
Very serious concerns
If the person is in school, what support do they have?
Robot Test (Required)
What is the 3 letter acronym for Bardet Biedl Syndrome?
Contact Information