Pre-registration ends at 5:00 p.m. on March 31st, 2010.

After that time, you can still register and attend at the walk-in registration table on April 2nd. Please print and fill out this form and bring it with you to facilitate processing. It will save you a lot of time!

Registration Form (one name per form - please print)
Important! Please read registration information

Save! Join now and attend the conference as a member.
Extended family and birthfamily members can attend under your membership.

 

_____________________________________________________
First Name/Last Name

_______________________________________________________________________
Member's First and Last Name if Different From Registrant

_______________________________________________________________________
Street

_______________________________________________________________________
City/State/Zip Code

_______________________________________________________________________
Telephone plus area code/Email for conference confirmation

 

Workshop Choices (Registrations are processed based on earliest postmark/fax receipt date with complete payment)

Workshop Time

1st Choice

2nd Choice

3rd Choice

9:45-11:00 a.m.

A______

A______

A______

11:15 a.m.-12:30 p.m.

B______

B______

B______

2:00-3:15 p.m.

C______

C______

C______

3:30-4:45 p.m.

D______

D______

D______


Presenter/Panelist:

__ No

__ Yes

    

Purchase Box Lunch:

__ No

__ Yes / $10

  

$_________

Family Membership:
(At One Address)

__ New / $50

__ Renewal / $50

  

$_________

Registration Fees, per person (PM=postmarked, FR=fax received date)

 

 

 

Member
(Per Person)

 

Non-Member
(Per Person)

Early Bird (PM/FR by 2/18)

 

$60

 

$125

Standard (PM/FR 2/19-3/25)

 

$90

 

$150

Late (PM/FR 3/26-4/2)
For registrations received after 5 pm 3/25, attendees need to bring their own lunch

 

$110

 

$175

 

 

 

 

 

 

 

 

 

Registration $_________

 

 

 

 

 

Donation (Please Check If You Prefer Anonymity)
___ Anonymous

 

Donation $_________

 

 

 

 

 

 

 

 

 

TOTAL $_________

Payment: ____ Check Enclosed -OR- Circle: Visa MasterCard Discover

Card Number_______________________________________________ Exp.________

Name on card __________________________________________________

3 Digit # on Back of Card ______________________________________

 

Parking:: ____ Will need handicapped parking

Mail or fax to: Adoption Community of New England, Inc.,
45 Lyman Street, #2, Westborough, MA 01581
Fax: 508.366.6813