SWC Individual Registration Form

2012 SayWhatClub Con · Salt Lake City, Utah · August 14-18, 2012

This form may be sent online by clicking the send button at the bottom. If you need help or have any questions regarding this form, please email Susan and Donna at SLC-con@saywhatclub.com

All fees are to be paid in USA Dollars and checks are to be made out to SayWhatClub Registration and mailed to:

Susan Dohne
SayWhatClub
509 Firewood Ave
Eustis Fl 32726

Your check must be received before you are considered officially registered.

Refund policy

If you wish to request a refund, contact Susan at SayCon2012@yahoo.com


Please click on the "Send Form" button when you have finished filling out the form.


Name:
State, Province, or Country you are from:

Will your spouse or S/O be attending?: No Yes
Name of Spouse or S/O if attending

Email:

SWC list: SWC members, please click the button by your home list.
CI
Connect
Menieres
Friends
Forum
Vistas
World
None

EARLY BIRD REGISTRATION (checks postmarked by May 31, 2011)
SWC Member - $100
Non SWC Member - $125
SWC Member and spouse - $175
Non Member and spouse - $200

REGULAR REGISTRATION (checks postmarked after May 31, 2011)
SWC member -$125
SWC member and spouse - $200
Non Member - $150
Non Member and Spouse - $250

One day only - $75
Two days only - $125

Where do you plan to stay during the convention?

Convention Hotel
Campground
Other

If you only plan to attend one or two days, which days will they be?

Do you use a wheelchair?  Yes No

Do you need a Large Print Program Book:  Yes No

Do you have any special dietary needs? Yes   No If so, please list them in the box below.


Do you plan to bring your children? Yes   No
If yes, please type in their names and ages.

The SWC is not responsible for providing child care. Parents will be responsible for their own children. If the child attends all of the evening social functions, there will be a $50 charge to cover expenses. If the child will only attend one evening function, please contact Donna at SLC-con@saywhatclub.com for the cost of that one event. There is no charge for children attending workshops.