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Become a HSC Member

Hemophilia of South Carolina welcomes you to register with us so we can keep you informed with information on events, advocacy initiatives, treatments therapies and research, fundraising opportunities, educational and networking opportunities. We invite those affected by bleeding disorders to register and we also welcome individuals, families, friends and affiliates who are interested in supporting our organization and share our mission. Download the registration form and fax, mail, or e-mail it to the Chapter or you may register online. Welcome to Hemophilia of South Carolina!

 

Downloadable HSC Membership Application

 

Online Application

Your Name (required)

Your Email (required)

Phone 1 (required)

Phone 2


Your Street Address (required)

City (required)

State (required)

Zipcode (required)


Family Member Name Age Relationship Check for Yes
Has Bleeding Disorder
Has Bleeding Disorder
Has Bleeding Disorder
Has Bleeding Disorder
Has Bleeding Disorder
Has Bleeding Disorder

What type of Bleeding Disorder are you or your family member(s) affected by?

Hemophilia AHemophilia BVon Willebrand DiseaseSymptomatic Carrier/Carrier
MildModerateSevere

Do you have an inhibitor? (required)

YesNo


My Affiliation Is:

Medical ProfessionalIndustry providing services/products to the bleeding disorder communityOther

Do you know anyone who may support/donate to/assist HSC? Please provide contact information.

Please prove you are human by selecting the Tree.