Family Conference Registration | The Foundation for Nager and Miller Syndromes

First & Last Name:*

Number of Attendees:*

Names of Attendees:*

T-Shirt sizes for each attendee (please indicate Adult or Youth sizes):*

Special diet restrictions or requirements:

Registration Fee: $15 - Individual or $30 - Family Fee may be paid via paypal donation system on the FNMS Web Site or via check mailed prior to room reservation confirmation.*

Your email address for confirmation of registration:*

Registration Form - 2010 FNMS Family Conference