Convo Registration Form

Instructions

Print out this form, fill it in, and mail it to: Convo 2002, 4021 W. 161 St., Cleveland OH, 44135-1237

Please include full payment by check or money order, payable to Interweave Continental, with the form!

Note - Canadian registrations must be paid in US dollars by money order only! We can’t process checks payable on Canadian banks...Sorry for any inconvenience.

• Each registration will be confirmed by mail or e-mail as soon as it is processed, however, registrations received after Feb. 8th, 2002 will be confirmed on site.
• All cancellations subject to a $25 fee. Cancellations must be received in writing by Jan. 15th, 2002 in order to receive a refund. No other refunds for any reason, including weather-delayed travel. :^)
• If you need assistance or more information, please e-mail hamiltonj2@aol.com. Feel free to copy this form!
• We have arranged for special rates with the Four Queens hotel in downtown Las Vegas. For Reservations and Information call 1-800-634-6045 and say you are part of Interweave Convo 2002!
  

Personal Information and Needs (for persons under 18 see release form below)

Name______________________________________ Address_______________________________________

City__________________________ State/Prov_____ Zip/Postal Code____________

Email____________________ Home Phone (____)______________ Work Phone (____)_____________

My UU Church____________________________________

My Food Preferences:

qVegetarian qVegan qOmnivorous  Note any dietary restrictions:__________________________________
qYes, I need child care! ($20 per child) # of children___________ Age(s)_____________

Fees (includes program, Friday dinner, and Saturday breakfast and lunch)
Interweave Member--$105_____ Non-member--$120_____ Sunday Lunch -- $20 _____

q I want to join Interweave! For only $30 a year, I can pay the reduced price for Convo, plus receive InterweaveWorld 3 times a year!! I’ll send in my $30 now!
q I need scholarship assistance      q I want to donate to a scholarship fund! Amount $_______

Total Enclosed $_____
Thank you for registering.  We hope you have a great time!

For registrants under 18: All youth under 18 must attend Convo with a parent or other adult sponsor who is also registered for the conference. 

My sponsor/parent is _____________________________________ Their phone_________________

Parent/guardian(s), please read and sign: I give my child, _______________________________ permission to attend Convo in Las Vegas, Nevada, February 15-17, 2002.  I give my permission for my child's sponsor, ___________________________ ,to provide supervision and make any emergency medical or legal decisions on my behalf.  I understand that the organizers/staff of Convo will not be providing supervision of youth attendees, and I agree to hold them and the board of Interweave Continental harmless. 

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