Consistent Life 25th Anniversary Conference Registration Form

Get clothing, buttons, bumper stickers, magnets, mugs and cards promoting a consistent life ethic at the CL Online Store

Donate

Online Registration Form
Consistent Life 25th Anniversary Conference
March 9-11, 2012
National 4-H Youth Conference Center
Chevy Chase, Maryland, USA

For full information on the Consistent Life 25th Anniversary Conference, see the Conference Web site.

All advance registrations must be received by Tuesday, March 6, 2012. Some walk-in registrations will be available at the Conference, but please register in advance if at all possible.

E-mail Address: *

Prefix:

First Name: *

Last Name: *

Title:

Street Address: *

Organization:

Phone Number: *

Address Line 2:

City: *

State/Province: *

Country: *

Postal Code: *

If this registration is for someone who is part of a family/group rooming together, and any confirmations or questions should go to a designated contact for the family/group, please provide that person's name here:

Are you under 18 as of 3/9/12? *

Are you interested in childcare during the conference? *

If yes, please provide the number and ages of children:

Do you have any special requirements/requests (including family needs)?

Fulltime Registration Fees (All fees listed in U.S. Funds): *

$150 Standard Conference Rate
$60 Scholarship Rate (Explain Below)
Registration Fee Not Applicable (Explain Below)

Parttime Registration Fee (registrant determined based on amount of time at conference & ability to pay)

Parttime period at conference

Will you be staying overnight? *

Yes
No

Explanation for Scholarship Rate/Registration Fee Not Applicable:

Please check all that apply:

Friday Night
Saturday Night
Additional Night(s) - please specify below

Additional Night(s):

Please reserve your room type (Price per person per night):

Standard Room: Single Occupancy $122 per person per night
Standard Room: Double Occupancy $61 per person per night
Bunk Rooms: 3 person room, $46 per person per night
Bunk Rooms: 4 person room, $37 per person per night

Enter Total Amount for Overnight Accommodations:

Please assign roommate(s) for me:

Individuals to include in the room: (These individuals MUST complete their own registration form; list first and last name)

Gender:

Male
Female

Healthy Meals will be served cafeteria style. Please check the meals you will share with us:

Breakfast - $10.50 per day:

Saturday 3/10/12
Sunday 3/11/12
Additional Breakfast(s)

Please specify day(s) for additional breakfast(s):

Enter Total Amount for Breakfasts:

Please specify day(s) for additional lunch(es):

Lunch - $14.00 per day:

Saturday 3/10/12
Sunday 3/11/12
Additional Lunch(es)

Enter Total Amount for Lunches:

Dinner - $16.00 per day:

Friday 3/9/12
Saturday 3/10/12
Additional Dinner(s)

Please specify day(s) for additional dinner(s):

Enter Total Amount for Dinners:

Meal Selection:

Vegetarian (lacto-ovo)
Vegan
Other (Please Specify Under Special Dietary Needs)
No Special Diet

Other Dietary Needs (Please List):

Compute Total Due

Registration Fee:

Total Overnight Accommodations:

Total Breakfasts:

Total Lunches:

Total Dinners:

Donation for Scholarships:

TOTAL:

Payment Instructions:

Will mail payment to: Registrar, Consistent Life 25th Anniversary Conference P.O. Box 9295 Silver Spring, MD 20916-9295 (Make checks payable to: Consistent Life)
Will pay online at: http://www.consistent-life.org/join.html (Note: Registration will not be considered complete until we have been notified by payment service that your payment has been received)

Verification Code: Visual Verification Image

Enter Verification Code: *

* Required