1. Personal Information
Name
Address
City State Zip
Phone
Email 2. Are you affiliated with any organizations?
Would your organization like to have a literature table at the Conference($25)? Yes No
3. How did you hear about us?
4. If you will be staying at a hotel, please indicate which hotel:
And what nights you are staying there? Friday Night Saturday Night
5. If you need housing, please indicate which nights you need it: Friday Night Saturday Night and whether or not you need special accommodations (i.e. pet free house, child safe house, etc)
6. Do you need meals? Saturday Breakfast Saturday Lunch Sunday Breakfast
7. Are you bringing children that will need supervising during the workshops? Yes No
If so, how many children?
8. Conference Costs: $10 due by March 7th. How much will you be sending?