NHF Colorado Consent to Contact Form

By completing the form below, you authorize The University of Colorado Hemophilia Treatment Center to release your contact information to NHF Colorado and to be added to our mail and email correspondence lists. NHF Colorado will then contact you by phone in order to obtain any additional information that may be relevant for determining program interest and eligibility. Your participation is completely voluntary and can be withdrawn at any time upon your request. Your information will not be used for any other purpose or released to any other parties. 

Household Information:
First Name
Last Name
Country
Address Line 1
City
State
Postal Code
I would like to be contacted by the chapter regarding education and community events
I would like to be contacted to volunteer
I am a (please check all that apply)
NHF Colorado measures it's success by its programs. Please indicate your FAMILIES areas of interest:
Family Member Information:
Indicate individuals name, DOB, Status (affected, caregiver, sibling etc.) bleeding disorder type, and severity:
WE WELCOME YOU!

NHF Colorado provides programming, education, and resources for individuals and families that are affected by genetic and chronic bleeding disorders. Our vision is to create an environment where you feel like part of a community, part of the solution, and empowered in your daily life through connection with others who can relate to you and your challenges. The chapter provides low cost and free opportunities throughout Colorado to create connections and allow a comprehensive understanding of available resources. Your participation is the most valuable part of our organization.