Member Consent to Contact Form : Get Involved : National Bleeding Disorders Foundation

By completing the form below, you authorize The University of Colorado Hemophilia Treatment Center to release your contact information to NBDF Colorado and to be added to our mail and email correspondence lists. Your participation is completely voluntary and can be withdrawn at any time upon your request. Your information will not be used for any other purpose or released to any other parties.

Household Information:

Name

First Name *

Last Name *

Address

Country

Address Line 1 *

City *

State/Province *

Postal Code *

I would like to be contacted to volunteer

Birthdate

Month

Day

Year

Bleeding Disorder Diagnosis

Family Member Information:

Area in which you live (Required)

Note (Required)

Please list all members of your household so we can best serve your families needs!

Indicate individuals name, DOB, Status (affected, caregiver, sibling etc.) bleeding disorder type, and severity:

WE WELCOME YOU!

NBDF Colorado provides programming, education, and resources for individuals and families that are affected by genetic and chronic bleeding disorders. Our vision is to create an environment where you feel like part of a community, part of the solution, and empowered in your daily life through connection with others who can relate to you and your challenges. The chapter provides low cost and free opportunities throughout Colorado to create connections and allow a comprehensive understanding of available resources. Your participation is the most valuable part of our organization.