Who We Are
Membership
What is a Bleeding Disorder?
Resources
Camp
- Bleeding Disorders Camp
Events
Donate
- Personal Donations
- Sponsorship Opportunities
BDH Coffee
Newsletter
Contact

Membership

Membershipeob2023-01-26T10:34:53-06:00

2023 Membership Registration Form

BDH membership brings you information, resources and access to activities that are fun for the whole family. Your family can join other families that make up our vibrant and growing community. By becoming a member of BDH you will receive all the latest news and updates. We request updates to your registration every year to keep our permissions and database up to date.

Are you or someone in your household associated with the Bleeding Disorders Community?(Required)

I or someone in my household has a bleeding disorder

I am unaffected

Member Name(Required)

First Last

Date of Birth(Required)

MM slash DD slash YYYY

Gender(Required)

Male

Female

Other

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Phone(Required)

Would you be interested in volunteering with BDH?(Required)

Yes

Maybe

What is this household members' association to the Bleeding Disorders Community? (check all that apply)(Required)

I have a bleeding disorder.

Spouse/Partner to someone with a Bleeding Disorder.

Parent/Guardian of a child with a Bleeding Disorder.

I work for an Industry Company that serves the Bleeding Disorders Community.

I work for the HTC or a Hematology office in the state of Iowa.

I am a carrier.

I am a relative of a person with a bleeding disorder.

I support someone affected with a bleeding disorder.

Other

Are you diagnosed with a bleeding disorder? If so, what kind?(Required)

Hemophilia A (Factor VIII)

Hemophilia B (Factor IX)

Von Willebrand disease (VWD) Type 1

Von Willebrand disease (VWD) Type 2

Other

What programs are you/your household interested in? (please select all that apply)(Required)

Membership Events

Fundraising Events

Summer Camp (ages 6-17)

Bloodline Newsletter

Is there anything more you would like to see offered by BDH?

Household members

Relationship

First Name

Last Name

Date Of Birth

Diagnosis (Hemophilia A, Hemophilia B, VWD, Other, N/A)

Gender

Sign me up for the BDH Email Newsletter

Yes!

Comments

This field is for validation purposes and should be left unchanged.

To educate, connect, and support those affected with bleeding disorders.

Connect With Us

CONTACT INFORMATION

Brooke Loving, Executive Director

Phone: 319 – 721 – 1664
Email: [email protected]

2023 Membership Registration Form

Connect With Us

CONTACT INFORMATION

Bleeding Disorders of the Heartland is a member of the following national organizations:

NATIONAL HEMOPHILIA FOUNDATION

HEMOPHILIA FEDERATION OF AMERICA

Membership

2023 Membership Registration Form

Connect With Us

CONTACT INFORMATION

Bleeding Disorders of the Heartland is a member of the following national organizations:

NATIONAL HEMOPHILIA FOUNDATION HEMOPHILIA FEDERATION OF AMERICA

NATIONAL HEMOPHILIA FOUNDATION

HEMOPHILIA FEDERATION OF AMERICA