Registration Form


Date:

June 5-6, 2008

Name:

Email:

Title:

Organization:

Address:

City:

State:

Zip:

Phone:

Meals:

Yes, I want vegitarian meals

Translation:

Yes, I require translation services

Attendance Dates:

Thursday (Town Hall)

Friday

Youth Conference:

There is space for only 200 people, priority will be given to students and young adults under 25 years of age.

Yes, I wish to attend the Youth Conference and I am under 25.

Yes, I wish to attend the Youth Conference.

Comments:

 

Refund Policy

No refunds. Registrations are transferable. You may send someone in your place if you are unable to attend.

Special Accommodation

If you are in need of special accommodations (e.g., sign language interpretation,) please contact the conference office at (410) 837-3885, or toll-free (866) 951-7775. TDD or TTY users may access this number via the Maryland Relay Network at (800) 659-8331.

Conference Office

Every Last Detail
2122 Saint Paul Street
1st Floor
Baltimore, MD 21218
Phone: (410) 837-3885
Toll-free Phone: (866) 951-7775
Fax: (410) 837-5883
Email: conference@breakchains.org

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