Registering online is not available, however, you can print the registration form and either mail or fax in your registration and payment. If you do not have Adobe Acobat Reader you may download it at the Adobe Website. To view, and print the Conference Registration Form . If you have any questions please call: 1(800)-828-CONF or email.
Below you will find the information on the Registration Form, if you are unable to open the registration form above. You can use this information to phone in your registration if you are paying by credit card only.
I. Special Package (Registration & Lunch)
Leader, Leader Applicant, LLL Peer Counselor, WIC Staff
1 day :$75
2 day $100
Spouse or Exhibitor
1 day: $45
2 day $60
LLL Member
1 day $80
2 day $105
Non-Member
1 day $90
2 day $115
Please indicate meal choice for each day attending:
Saturday meat__ veg___ Sunday Meat___ Veg___
II Regular Registration (No Lunch)
Leader, Leader Applicant, LLL Peer Counselor, WIC Staff
1 day :$65
2 day $80
Spouse or Exhibitor
1 day: $35
2 day $45
LLL Member
1 day $70
2 day $85
Non-Member
1 day $80
2 day $95
total registration costs: $_____
Friday Evening Keynote Address
(one ticket free with each paid registration)
Addition tickets desired ___at $5.00 each = $______
Donations
Leader Confernce Education Fund_____
(3 drawing tickets per $1.00 donated)
LLLI Membership ($30) ____
Total Donations $ ____
Continuing Education Fees
Saturday $10.00x ____sessions ($30 max) $____
Sunday $10.00x ____sessions ($30 max) $____
Total CEHP Fees $____
Meals (only if purchased seperately from Special Package in Section 1)
Saturday Luncheon
Adult Meat #___x$18.00= $____
Adult Vegetarian #___x$18.00= $____
Child Meat #___x$8.00= $____
Child vegetarian #___x$8.00 = $____
Saturday Night Barbecue Dinner
Adult Dinner # ____x $18.00= $___
Child Dinner #___x$ 8.00 =$____
Sunday Luncheon
Adult Meat #___x$18.00= $____
Adult Vegetarian #___x$18.00= $____
Child Meat #___x$8.00= $____
Child vegetarian #___x$8.00 = $____
Total Meals $ ____
Fee Summary
Registration Fee $____
Late Fee ($15.00 after April 15) $______
Phone Registration Fee ($5.00) $_____
Total Keynote tickets $ _____
Total Donations $______
Total CEHP Fees $_____
Total Meals $___
Total Fees $_____
NAME_________________LLL/prof.credntials________ ADDRESS____________________________ CITY__________________STATE_________ ZIP___________PHONE( )____________SPOUSE/CHILD INFORMATION If spouse is attending sessions, s/he MUST register on separate form and choose his/her own sessions. Spouse’s Name ____________________________ Number of Children Attending____ Ages_________
STATUS (check all that apply) ____MEMBER ____LEADER APPLICANT ____CONFERENCE COMMITTEE ____LLL PEER COUNSELOR ____HEALTH CARE PROFESSIONAL (title______________)
Billing Information
Credit Card # ____________________ Auth # _____ Expiration date ________
Period Choices
Saturday
Period I first ___second____
Period II first ____ second ____
Period III first ___ second ____
Period IV first ___ second___
Sunday
Period V first ___second____
Period VI first ____ second ____
Period VII first ___ second ____
Period VIII first ___ second____
Please list those periods for which you are willing to be a ticket taker ___ ___ ____ ____
*Ticket takers are a valued resource and will be given 1st choice of sessions if session is not staffed. The Conference Needs you!
Saturday Evening Family Entertainment
How many people (you, your family, your friends) will be attending this special evening of FREE entertainment? ____
Hostess/Host/ Teen Helper (13 & up ) Application
Name____________________
Please elect time blocks you are willing to work. You will miss sessions if you select time slots during session times. Please make note of what age child may accompany you while on duty at each facility.
BOOKSTORE (no children)
Friday
___4:00-5:30 p.m.
___5:30-7:00 p.m.
Saturday
___10:00-12:00 Noon
___12:00-1:15 p.m.
___1:15-2:45 p.m.
___2:45-4:15 p.m.
___4:15-6:00 p.m.
Sunday
___10:00-12:00 Noon
___12:00-1:15 p.m
. ___1:15-2:45 p.m
. ___2:45-4:15 p.m.
___4:15-6:00 p.m.
*CHILDREN’S ACTIVITIES (OLDER CHILD)
Saturday
___8:15-10:00 a.m.
___10:00-11:45 a.m.
___1:15-3:00 p.m.
___3:00-4:45 p.m.
Sunday
___8:15-10:00 a.m.
___10:00-11:45 a.m.
___1:15-3:00 p.m.
___3:00-4:45 p.m.
*We are still seekin a person or group of people to coordinate Children’s Activities. To volunteer, please contact Sue or Karen . Host/Hostess/Teen Helpers for this area will be notified if we do not find a coordinator
MEALS (baby in carrier)
Saturday Luncheon ___11:45-1:15 p.m.
Saturday Night BBQ ___5:45-7:15 p.m.
Sunday Luncheon ___11:45-1:15 p.m.
GENERAL HELP
Information and Directions
(baby in carrier or older child)
Friday
___3:30 p.m .- 5:00 p.m.
___ 5:00 p.m.- 7:30 p.m.
Saturday
___8:00 a.m .- 9:30 a.m.
___9:30a.m . -11:00 a.m
. ___11:00 a.m .-12:30p.m.
___12:30 p.m. -2:00p.m.
___2:00p.m .-3:30p.m
___3:30 p.m .-5:oop.m.
Sunday
___8:00a.m .-9:30a.m.
___9:30a.m 11:00a.m.
___11:00a.m .-12:30p.m.
___12:30p.m .-2:00p.m.
___2:00p.m .-3:30p.m.
___3:30p.m .-5:00p.m.
This page maintained by Merri, for Southern California/ Nevada La Lecxhe League. Last updated 3/31/98.