Name of Institution or Affiliation
Current Position or Title
Attending meeting as (check all that apply)
Do you or your loved one fall into one or more of these categories? (select all that apply)
My child's mitochondrial disease has neurological issuesAs an affected adult, my diagnosis includes mitochondrial myopathyAs parent or caregiver of an affected adult, his/her diagnosis includes mitochondrial myopathyNone of the above
Do you plan on attending in person or remotely?
Please check if this is your first PFDD meeting
(Kosher, vegetarian, allergies, etc.)
(Wheelchair accessibility, hearing impaired, etc.)
We will be taking pictures and videos during the conference to include in future newsletters, on our website, and in literature promoting our mission. Do you give consent to use these photos?
Which nights will you be staying at the College Park Marriott?
Thursday, March 28, 2019Friday, March 29, 2019I will not be staying overnight at the MarriottUnsure
(UMDF has a special group rate for $159/night plus taxes)
UMDF will be providing a limited number of travel scholarships to patients/families (adults and adult caregivers with mitochondrial myopathies and parents/caregivers of children suffering neurologic manifestations in mitochondrial disease). Please indicate if you require a travel scholarship to attend.
Is there anything we didn't ask that we should know about?