Skip survey header

PSM Registration

2019 Boston Pachyonychia Congenita (PC) Patient Support Meeting (PSM)

June 20-22, 2019. Meeting will be held at the Hilton Boston Logan Airport Hotel.

The meeting will begin on Thursday, June 20th with registration and an opening dinner that evening. The main presentations and discussions will take place on Friday, June 21st. Breakfast, lunch and dinner will be included on this day. Saturday, June 22nd will begin with breakfast, followed by meetings and conclude with a closing lunch.

For information on meeting fees, hotel registration and scholarships, please visit https://www.pachyonychia.org/2019PSM

NOTE: Once you submit the registration you will be redirected to PayPal Giving Fund to pay the meeting fees. If you have PC and are attending a PSM for the first time, the meeting fees are waived for you and one family member. Please pay additional fees for any other family members or close the PayPal Giving Fund window to finish.
1. Your contact information. *This question is required.
2. Please tell us a little about yourself.
3. Have you (as a PCer or as a caregiver for someone with PC) submitted the International PC Research Registry (IPCRR) Consent Form, Questionnaire and photos to PC Project for the IPCRR?
4. Will this be the first time you have attended a PC Patient Support Meeting?
7. We hope you will be attending all sessions. If you are arriving late or leaving early, please mark which sessions you will be able to attend. 
8. Please provide information for those who will attend the meeting with you.
Space Cell NameRelationshipAge (if under 18)Do they have PC?Special dietary or other needs
Attendee 1
Attendee 2
Attendee 3
Attendee 4
Attendee 5
Attendee 6
Attendee 7
10. Photo & Video Consent Form
- I hereby give my consent to have photographs and/or video taken of myself (or/and my child/children) which will be used by PC Project or PC Project Europe for educational, promotional and research purposes.
- I understand that these photograph(s) and/or video may appear in the public media, including print, internet and/or broadcast media for an indefinite period of time.
- I have been informed that these photograph(s) and/or video may be used more than once for educational and promotional purposes by PC Project.
- I understand my name and personal identifying information will not be associated with the photograph(s) and/or video without my additional written consent.
- I understand I have the right to withdraw the photograph(s) and/or video by a written request to PC Project. *This question is required.