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The Amazing Goosechase: Bleeding Disorder Edition (MHA Registration Form)
MHA Registration Deadline - April 7
GooseChase Game Play Begins April 10 & Ends April 16
One registration per household.
Link to Game with Password will be emailed out April 8 to registrants for the start of the game.
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* Indicates required question
First Name
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Your answer
Last Name
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Your answer
Team Name - *Come up with a team name for your household. Please include "MHA" at the beginning or end of the name
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Your answer
Phone Number
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Your answer
Email - *make sure to use a primary email to play GooseChase and receive any digital gift cards.
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Your answer
Mailing Address - to be used to send any physical prize won
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Your answer
City
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Your answer
State
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Your answer
Zip Code
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Your answer
Please choose one:
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I live in the MHA coverage area (Kansas, Western Missouri, and/or seen at the KC Regional Hemophilia Treatment Center
I do not live in the MHA coverage area, but add me to the waitlist for open spots.
Photo Consent: From time to time, the Midwest Hemophilia Association will want to use pictures and/or videos from our programs to promote bleeding disorder programs and MHA's activities. We ask permission to be able to use your image or those who have registered for that purpose.
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I give my permission to use my image in print, video, or electronic media, including internet and social media.
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