Black Voices Virtual Quarterly Call Registration

EVENT CONFIGURATION (STAFF USE ONLY)

NOTE FOR STAFF: To update this form for each quarter, update these values for the next call and update the text in the paragraph below.

Date of next Call:

Descriptive Date of next Call:

Time of next Call:

Purpose:
HFA is pleased to invite you to our Black Voices Virtual Quarterly Call, a virtual meeting for Black and African American members of the bleeding disorders community (ages 18+) from across the US.

As part of HFA’s Black Voices initiative, the calls help build dialogue around personal experiences related to healthcare access barriers and advocate for solutions.

Goals:
1. Identify shared and common health access issues experienced by the Black-Identified and African American communities that may be underrepresented in bleeding disorders policy and advocacy efforts.
2. Identify possible solutions that close the gap to unmet needs in healthcare access, affordability and support.
3. Identify opportunities to advocate for more equitable access to care on behalf of the bleeding disorders community.

Date: Thursday, Oct. 22, 2026

Time: 7:00pm-8:30pm EST/4:00pm-5:30pm PST
Location: Zoom (Virtual) - Zoom conference link will be provided after registration and publicly available on HFA’s website

If you have any questions, please reach out to hfaprograms@hemophiliafed.org. For more information about HFA, visit our website at www.hemophiliafed.org.

Are you currently employed professionally within bleeding disorders (i.e. pharmaceutical manufacturer, specialty pharmacy, bleeding disorder patient organization, healthcare professional, etc)?

YesNo

Please note you will be expected to attend the Black Voices Quarterly Check-In solely in a community role. Any branded materials from your employer (clothing, business cards, etc) and any attempt to market products or your services are disallowed.

I understand the need for and I agree to protect the confidentiality of any and all personal information shared by all participants during HFA activities in which I am involved. I agree that I may not discuss any personal information learned with any individual, entity, or representatives of any pharmaceutical company, treatment center, homecare provider, pharmacy, or other healthcare provider.

I agree.

I authorize the use of photographs or videos for HFA purposes only.

YesNo(Note: you may rescind authorization at any time.)

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	Other

Inhibitor	Hepatitis C
HIV	Joint Damage
Depression	Diabetes
Heart Disease	Liver Cancer
Other