Registration for
The 2011
November Adoption Conference
in honor of National Adoption Month
sponsored by
Adoption Comminity of New England, Inc.
Workshop Selection:
Please select one workshop from each session (A, B, C, and D)
__A1 __A2 __A3 __B1 __B2
__C1 __C2 __D1 __D2
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Name
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Address
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Address Line 2
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City/State/Zip
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Email Address for registration confirmation
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Phone
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Name of Agency if coming under agency membership
Please check appropriate amount:
Faxes received/Postmarked by 5 p.m. November 8, 2011.
____ $50.00 - per attendee, member
____ $60.00 - per attendee, non-member
Join ACONE now and attend as a member.
____ $35.00 Conference Special! Individual/family membership
Regular rate $50.00 (You save $15!)
____ $100.00 for agency/organization membership
Please consider making a donation to provide for scholarships.
__________ Donation
__________ Total dollars enclosed or to be charged
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MC/Visa/Discover #
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Expiration date
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Three-digit code on back of card
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Name on card
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Signature of cardholder
Mail this form and payment to: ACONE, Inc., 34 Deloss Street, Framingham, MA 01702.
Registrations charged on MasterCard, Visa or Discover may be faxed to us at 508.872.2231
