1999 Tri-State Regional Bisexual Conference
February 5-7, 1999
Registration Form
Name: _________________________________________
Name as will
appear on badge: ________________________________
Address:_______________________________________
_______________________________________________
__________________________ Zip Code: ___________
Telephone: (________)___________________________
Email: ________________________________________
Best way to contact you? ________________________
Will you be attending as part of a group/affiliation? ____
If so, which? ___________________________________
| Volunteering: (check one if interested) |
I would like to:
be part of the entertainment__________________
lead a workshop? __________________________
help with registration and similar functions the weekend
of the conference? __________________
other: _____________________________________
| Community housing: (check one if interested) |
____ Please help me to find community housing during the conference.
____ I can provide community housing for ________ people.
| Transportation: (check one if interested) |
____ Please help me find a ride to the conference.
____ I can provide a ride for _______ people.
| Dietary Preferences: (please, list) |
Please, list below special dietary needs: (veg., low salt)
____________________________________________
T-shirts will be available for purchase at the conference to
commemorate the event. They will incorporate the conference logo on
the back of each shirt on white (50/50 cotton/polyester blend). You
may purchase shirts for $12 in advance or $15 at the conference.
I would like __________(# of shirts).
Size(s):
S_____,M_____,L_____,XL_____,XXL_____XXXL_____
Before January 31, 1999:
$35 students/low income
$45 general admission
$55 on-site registration, February 5, 1999
Please, indicate if you are a registered as a Rutgers University Student
for the Spring 1999 semester:
Yes:_________
Total
Amount Quantity Total
Registration: ________ x ________ = __________
T-shirts: ________ x ________ = __________
Total: __________
| Payment & Mailing Instructions |
When complete, please, detach your registration form from the brochure.
Include a check for the total amount listed above. Make check payable
to: BiNet/USA and mail to:
TBC 1999
13 Dartmouth Ave. Apt. 3B
Bridgewater, NJ 08807-3420
OR
Rutgers students can send to DPO 26866
We will send you confirmation of registration upon receipt.