International Annual Patient Conference Registration

Thank you for your interest in attending TMA’s International Annual Patient Conference! You can preview the form in PDF format. Please visit our website for information about the conference program, accommodations, and more. Use this form to register for the conference, Heroes in the Fight, or both the conference and Heroes in the Fight.

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Add any additional non-US address information *

Zip Code *

Country

Phone Number *

Email Address *

Attendee Type *

Form of Myositis *

How long has it been since your diagnosis? *

Less than one year

1 to 5 years

5+ years

Are you a first time attendee to the IAPC? *

Yes

No

Are you a veteran? Have you ever served on active duty in the U.S. Armed Forces, military Reserves, or National Guard?

Yes

No

Emergency Contact

Who should we contact during the conference in case of emergency?

Full Name *

Phone Number *

Email Address *