TexasJAM: In-Person Community Event

Registration

Contact Information

First Name *

Last Name *

Credential(s)

Primary Role in Community *

Person With IgG4-RD Caregiver Family Member Friend Physician Physician Assistant Nurse Practitioner Nurse Mental Health Professional Allied Health Professional Researcher Industry

Email *

Country *

Event Attendance

Will you be joining us for the full TexasJAM event on November 14? *

I will be attending the full day I will ONLY be attending the morning sessions I will ONLY be attending the afternoon sessions

Will you be attending the evening reception with appetizers and cocktails on November 14? *

Yes No Third choice

Dietary Restrictions or Preferences

Please let us know if you have any dietary restrictions or food preferences.

Accessibility & Support Needs

Please let us know if you require any accessibility accommodations or support to fully participate in this event (this does not include lodging).

Payment Details

Price text

Industry registration

Price: $500.00

Optional donation

Discount code