Attendee Name (Required)
First Last Address (Required) Pronouns How do you identify your ethnicity? (Select all that apply) Dietary Restrictions (Required) Participation
This form is both the registration for the FD/MAS Alliance Community Conference as well as the International Consortium for FD/MAS Research Meeting. If you wish to sign up for only one meeting or the other, please indicate your choice here:
Which dates will you attend the conference? Both Saturday and Sunday, September 9th and 10th - The Community Conference and the Research Meeting Only Saturday, September 9th - FD/MAS Alliance Community Meeting Only Sunday, September 10th - International Research Conference - ICFDMAS Are you interested in a medical consult?
On Friday, September 8th, we will offer 20 minute medical consultations with clinical experts in FD/MAS. There is limited availability for these appointments and they will be scheduled on a first-come-first-serve basis.
Are you a participant in the NIH natural history study of FD/MAS? Are you interested in participating in the Faces of FD/MAS project?
FD/MAS Alliance will have a videographer on site to capture and record the stories and experiences of those in the FD/MAS community. If you would like to learn more about this project and, potentially, sign up for a recording slot, please indicate so below
Waivers Photo/Video Release (Required)
I hereby grant FD/MAS Alliance permission to use my likeness in a photograph or video in any and all of its publications, including but not limited to all of FD/MAS Alliance's printed and digital publications. I understand and agree that any photograph or video footage using my likeness will become property of FD/MAS Alliance and will not be returned.
I acknowledge that since my participation with FD/MAS Alliance is voluntary, I will receive no financial compensation.
I hereby irrevocably authorize FD/MAS Alliance to edit, alter, copy, exhibit, publish or distribute this photo or video for purposes of publicizing FD/MAS Alliance's programs or for any other related, lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph and video footage.
I hereby hold harmless and release and forever discharge FD/MAS Alliance from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.
Hidden Code of Conduct
FD/MAS Alliance is committed to providing a friendly, safe and welcoming environment for all, regardless of gender, sexual orientation, disability, race, ethnicity, religion, national origin, or other protected characteristics at its conferences and events, whether held in-person or in virtual format.
We expect all participants and attendees (whether participating in-person or remotely), media, speakers, volunteers, organizers, and exhibitors to help us ensure a safe and positive experience for everyone. This code of conduct outlines our expectations for participant behavior, as well as the consequences for unacceptable behavior. FD/MAS Alliance promotes equal opportunities and treatment for all participants. All participants are expected to treat others with respect and consideration, follow venue or virtual forum rules, and to alert staff to any violations of this Code of Conduct, dangerous situations, or any participant in distress. This Code of Conduct applies to participants at any FD/MAS Alliance-sponsored event, including virtual and live events. CODE OF ETHICAL CONDUCT: • Be considerate, respectful, and collaborative. • Refrain from demeaning, discriminatory or harassing behavior and speech. • Be mindful of your surroundings and of your fellow participants. Alert FD/MAS Alliance staff if you notice a dangerous or harassing situation or someone in distress. UNACCEPTABLE CONDUCT: Unacceptable behaviors include: • Intimidating, harassing, abusive, discriminatory, derogatory, or demeaning speech or actions by any participants at or in relation to the live or virtual event and related event activities. All who participate in the events deserve respectful treatment, regardless of the capacity in which they are attending or participating. Discussion of opposing or different viewpoints is appropriate but is expected to be conducted in a respectful tone and manner that avoids personal attacks. • Harassment behavior, such as: using offensive verbal comments related to gender, sexual orientation, race, religion, national origin, gender identity, or disability; inappropriate use of nudity and/or sexual images in FD/MAS Alliance-sponsored spaces or presentation slides; deliberate intimidation, virtual or in-person stalking or unwelcome following; harassing photography or recording; yelling at or threatening speakers; sustained disruption of talks or other events; unwelcome physical or verbal contact or sexual attention. • Verbal or physical abuse, intimidation, threats, efforts to annoy others, harassment or stalking, which in any way creates a disturbance that is disruptive or dangerous or creates reasonable apprehension in a person. CONSEQUENCES OF UNACCEPTABLE BEHAVIOR: Unacceptable behavior will not be tolerated at live or virtual meetings or related events, whether by participants, media, speakers, volunteers, organizers, sponsors or exhibitors. We expect all event participants (staff, sponsors, volunteers, and speakers) to abide by this code of conduct at all live and virtual meeting events. FD/MAS Alliance, in its discretion, may bar those who violate this Code from continued participation in or attendance at some or all FD/MAS Alliance events (live or virtual), without refund of any fees paid. Anyone asked to stop unacceptable behavior is expected to comply immediately. I agree to the code of conduct Code of Conduct (Required) Experience How did you learn about the conference? Checkout Select Your Ticket Very Early Bird - $250.00 (Available 2/20 - 5/31) Early Bird - $350.00 (Available 6/1 - 7/31) One Day Only - $225.00 (Available 2/20 - 8/25) Students (12 - 22) - $225.00 (Available 2/20 - 8/25) Full Price -$400.00 (Available 8/1 - 8/25) Under 12 - Free