IWC

2009 Registration Form

One woman per registration form please

Name
Phone Number 
Address


City:

State: or Province:

   
Zip or Postal Code:
   
Country:  
 
Email Address
Sobriety Date
Name on Badge
Would you like to be of service?  Check all that apply:
Panel Workshop Marathon Greeter
Do you have special needs? (specify) Check all that apply:
ASL Wheelchair
Other:
$35.00 Registration Fee
Previously Registered 		$35 (One woman per application please.)
$35 (Add Banquets, Souvenirs, or Scholorships)
Meals Friday Night Banquet ($35)
Check here for Vegetarian Meal:

Saturday Night Banquet ($42)
Check here for Vegetarian Meal:

Sunday Brunch ($27)

Group Seating

Banquets and brunch have reserved seating. To sit with friends, please indicate their names in the space provided.

Is group seating necessary?
If yes, please indicate with whom you'd like to be seated:
Souvenirs
Vintage Football Jersey

 S M L XL
$20.00

quantity:


XXL XXXL
$22.00

Full Zip Fleece Jacket W/Hood

S M L XL
$34.00

quantity:



XXL XXXL
$36.00

Stainless Steel Travel Mug
$8.50

quantity:

Coffee Mug
$5.00

quantity:

Conference Tote
$15.00
quantity:
 
Scholarship Fund  Optional donation amount $:
Your Total is:

4.0% transaction fee included

No registration confirmation will be sent. Your debit charge from PayPal is your receipt.
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