Rendez-vous Sponsorship Application
Rendez-vous 2017 is being held May 25-28th in Toronto, ON.
Applicant Name: *

Applicant Home Region: *

What level of sponsorship are you applying for? *

Applicants who select "Either one" will be considered for a Full sponsorship first. If they are unsuccessful, they will be considered for the Partial sponsorship next.

Do you meet the following eligibility criteria:

I am a person with hemophilia, von Willebrand disease, a rare factor deficiency, or a platelet function disorder, including carriers; OR an immediate family member of someone affected by one of those conditions, OR a long-time Hemophilia Ontario volunteer. *

I am able to communicate in English or French, the official languages of Rendez-vous; *

I have been an active volunteer in the inherited bleeding disorders community for at least the past year. *

I am committed to volunteering with Hemophilia Ontario for at least the next two years. *

I agree to attend all conference activities, including medical symposium, CHS Annual General Meeting, and community education sessions. *

I will provide a report to the Hemophilia Ontario Board of Directors within one month of the conclusion of the conference, explaining the knowledge gained at the conference, and how Hemophilia Ontario might use this knowledge to enhance our mission. *

Within one month of the conclusion of the conference, I will write an article for Blood Matters sharing my experience with the inherited bleeding disorders community. *

I understand that failure to fulfill any of these criteria will be considered by Hemophilia Ontario when reviewing future applications for funding opportunities. *

I want to attend Rendez-vous 2017 because: *

Attending Rendez-vous 2017 will help me become more involved with Hemophilia Ontario in the following ways: *

Best phone number to reach applicant during the day: *

Your application has been received! Thank you for your interest.
All applicants will be contacted after the deadline to let them know whether or not they have been successful.
More information about Rendez-vous 2017
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