2025 ANN Conference Registration - American Nystagmus Network

REGISTRATION

For questions, please contact Evelyn Gonzalez at [email protected] or (510) 304-7122 (Pacific Time Zone)

Name(Required)

First Last

Your Address

Street Address City ZIP Code

Phone Number

Email(Required)

Share my contact information with other conference attendees. We will provide a conference contact spreadsheet for those interested in sharing their information. *

Yes

No

Dietary Restrictions

Who Is Attending The Conference?

We’ll need to know who will be attending the conference (adults and children) and if children will be attending Camp Nystagmus.

How many adults (or children NOT attending Camp Nystagmus) will attend the conference?

Price: $225.00

Name of adult(s) attending conference.

For additional names, click the blue plus icon to the right.

First

Last

Do you have a child attending Camp Nystagmus?

Yes

No

The cost of your first child to attend Camp Nystagmus is $75. Additional children can attend Camp Nystagmus for $50 per child.

Name of child attending conference.

First

Last

Age of child attending conference

Grade Fall 2025

Do you have more than one child attending Camp Nystagmus?

Yes

No

How many additional children will attend Camp Nystagmus

Price: $50.00

Please list names, ages, and grade for fall 2025 for each additional child attending Camp Nystagmus.

For additional names, click the blue plus icon to the right.

Name

Age

Grade Fall 2025

Conference Tee Shirt Order

If you’d like to order a conference Tee shirt, please indicate the size and quantities below. Adult sizes are $15 and child sizes are $10.

ADULT Conference Tee Shirt

Quantity

ADULT Conference Tee Shirt

Quantity

ADULT Conference Tee Shirt

Quantity

YOUTH Conference Tee Shirt

Quantity

YOUTH Conference Tee Shirt

Quantity

OPTIONAL DONATION

The registration does not cover the total cost of the conference. We are also hosting a nystagmus research workshop prior to the conference. The workshop brings nystagmus researchers from around the world to share their knowledge and advances. We appreciate any donations you can make to help us fund this conference and the research workshop.

Total Cost For Registration

Total of registration fees, donations, tee-shirts, and Camp Nystagmus.

Total Due

Payment Options

We have three ways to pay your registration fees. You may send us a check, pay via Venmo, or pay with Paypal. Please indicate below which you’ll be doing.

Payment Options

I’ll mail a check

I will pay with Venmo

I will pay with PayPal