SWC Individual Registration Form

2004 SayWhatCon · Bloomington, Minnesota · July 14 - July 18, 2004

This form may be sent online by clicking the submit button at the bottom. If you need help or have any questions regarding this form, please email Susan Dohne, chair of Registration at FireAntz@aol.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
502 Lake Gracie Drive
Eustis, Florida 32726

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

Refund policy

If you wish to request a refund, contact Cathy at travelincathy@cawamn.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: Please click the one you would like to see on your name tag, even if you are on more than one list

CI
Connect
Deaf/Hearing Couples
Friends
Forum
Global
Network
Our Children
Vistas
World
None

EARLY BIRD REGISTRATION (checks postmarked by April 1, 2004)
SWC Member - $100
SWC Member and spouse - $175

REGULAR REGISTRATION (checks postmarked after April 1, 2004)
SWC member -$125
SWC member and spouse - $200
Non Member - $150
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 use an Interpreter? 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 Cathy for the cost of that one event. There is no charge for children attending workshops.

The Circle discussion from 8:00AM-9:00AM will be led by Bob Elkins. It will be limited to about 15 participants per session. Click on one of the below circles for the day you wish to attend or if you do not plan to attend. Those who register first will receive preference as to the day they select. If you pick a day that is already full, you'll be notified of an alternative day.

I would prefer to attend this workshop on
Thursday Friday Saturday Will not attend