Printable Registration Form - 2006 OC Conference
Please return
form below
via:
e-mail:
conf2006@oc-tech.org
fax:
617-720-6190
mail: 14 Beacon St. #707, Boston, MA 02108
___YES, I'll
be attending the conference on June 17. Enclosed is my $60 per person
for __ people for
a total of $______ (student/limited income rate $30/pp., workshop presenter rate $15/pp. to cover food)
___YES, enclosed is $50 per person for __ people attending
at the
special OC member rate for a total of $______.
___I am enclosing _____ for ___ (new / renewal) memberships in OC at
the rate of $______ per person (special rate of $20 for new members).
___Yes, I am planning to attend the Sat. Post-conference Supporters' dinner
(At South Kitchen and Wine Bar - $55, or $50 with conference registration) to benefit OC's efforts to fight the digital divide.
| Additional names and emails of people attending: |
__________________________________________________ |
|
__________________________________________________ |
___ I can't attend, but keep me informed.
___I can't attend but I like what Organizers' Collaborative is doing and I have enclosed $_______.|
Name:_______________________________________ Address: ____________________________________ City/State/Zip: _______________________________ Phone: ______________________________________ E-mail: ______________________________________ Org. Affiliation (if not in address)____________________________ |
|
Please make checks out to "Organizers' Collaborative", or fill out credit card information and send by fax, mail, but NOT email. Cardholder________________________________________ VISA/MC/AMEX#:__________________________________ Expiration Date: _______/________ For AMEX only, your 4-digit security code located on the front above and to the right of your card number:______ |
