The Vascular Birthmarks Foundation

Dr. Linda Rozell-Shannon, PhD President and Founder

Conference Registrant Details

We look forward to welcoming you to the 2022 Annual VBF Super Clinic in California! Use the form below to complete your party's registration. You can email any questions or concerns to chris@birthmark.org.

To register for the conference, we require some information about the registrant, the patient, the patient's birthmark, including a required photo upload showing the birthmark, your preferences for services and sessions and any other people in your group who may be attending, such as other parents or children.

You will have the opportunity to review a summary of your information before proceeding to the final step to enter your billing information and submit your registration form. To get started, fill out the information below, then click on NEXT STEP at the end of each segment to continue.

For this section, please include information for yourself, the registrant. The registrant is the parent, guardian, or spouse of the patient with a birthmark or the adult with a birthmark.

Registrant Contact Information

 
 

Please note, due to COVID-19, we are unable to assist in securing a visa to the US. If you need a visa, please contact your embassy to find out requirements.

Please note, due to COVID-19, we are unable to assist in securing a visa to the US. If you need a visa, please contact your embassy to find out requirements.
 

Please tell us about the patient who will be attending the conference

 

Please tell us about your birthmark so that we can provide the most appropriate services.

Who is the patient's current physicians? (add up to 3)


Please provide a photo clearly showing the patient's birthmark so that we can best tailor our conference services for you. (JPG or PNG please less than 5 mb in size). A photo is required and is necessary to assign you to the appropriate clinical teams. If you are unsuccessful at uploading a photo here, you must email a photo of your birthmark to chris@birthmark.org. When emailing, please include in the subject line the registrant's name so that we can file appropriately.


For any other photos or documents you wish to share with us, please upload them here. If you are unsuccessful uploading, please email any documents to chris@birthmark.org.

Dr. Linda Rozell-Shannon (PhD), President and Founder

Vascular Birthmarks Foundation, PO Box 106, Latham, NY 12110

We are an international charitable organization that networks those affected by a vascular birthmark, anomaly, tumor or syndrome to the appropriate medical professionals for evaluation and treatment. VBF also educates physicians and affected families regarding treatment options, supports relevant research, mobilizes medical missions, and empowers those living with vascular birthmarks.

The Vascular Birthmarks Foundation is a 501(c)3 charitable organization - Federal Tax ID 16-1515227