Registration
The total number of people per delegation is 13 (This INCLUDES Advisors/CC's/and delegates).
Deadlines______________________________
Registration Opens: September 3, 2014
Registration Closes: October 3, 2014 Gender-Neutral Housing Forms: October 10, 2014 |
Delegate costs_________________________
Student Delegate: $141.50
Advisor Delegate: Double Room: $191.50 Single Room: $241.50 |
information to be gathered before completing registration______________________
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Institution Information
Delegation Name Institution Name Residential Life Phone Number Estimated Time of Arrival on October 31 Billing information Billing Address Method of payment (for invoice purposes, you will not submit payment today) NCC/NRHH CC Information Last, First Name: Identified Gender Is individual interested in gender neutral housing: (Yes/No) Email: Phone Number: First time or Returner to GLACURH: T-Shirt SIze: Insurance Agency: Insurance Policy Number: Emergency Contact Name/Relationship: Phone Number: Banquet Selection (Meat or Vegetarian): Any Allergies/Special Dietary Needs: Do you need any special accommodation? If so, please specify: |
Delegate Advisor Information
(Professionals Attending the Conference with your Institution) Last, First Name: Identified Gender Is individual interested in gender neutral housing: (Yes/No) Email: Phone Number: Single or Double Room: T-Shirt Size: Insurance Agency: Insurance Policy Number: Emergency Contact Name/Relationship: Emergency Contact Phone Number: Banquet Selection (Meat or Vegetarian): Any Allergies/Special Dietary Needs: Do you need any special accommodations? If so, please specify: Other Student Delegates/Alternates Information Last, First Name: Email: Identified Gender: Is individual interested in gender neutral housing: (Yes/No) First time or Returner to GLACURH: T-Shirt Size: Insurance Agency: Insurance Policy Number: Emergency Contact Name/Relationship: Emergency Contact Phone Number: Banquet Selection (Meat or Vegetarian): Any Allergies/Special Dietary Needs: Do you need any special accommodation? If so, please specify: |
Banquet Menu
Salad: Market House Salad with Homemade Croutons and Balsamic Vinaigrette
Meat Entree: Lemon Parmesan Chicken Breast with White Wine Chive Sauce
Vegetarian Entree: Portobello Mushroom layered with Zucchini, Spinach, Roasted Red and Yellow Peppers, Polenta and Mozzarella on Roasted Tomato Coulis
Side Dishes: Fresh Green Beans & Carrot Medley & Oven Herbed Roasted Potatoes
Dessert:
Old Fashioned Chocolate Layer Cake
Cheesecake with Seasonal Berries
PLEASE INDICATE ON DELEGATION REGISTRATION FORM IF ANY INDIVIDUAL HAS SPECIFIC DIETARY NEEDS THAT ARE NOT MET BY THE ABOVE MENU.
Meat Entree: Lemon Parmesan Chicken Breast with White Wine Chive Sauce
Vegetarian Entree: Portobello Mushroom layered with Zucchini, Spinach, Roasted Red and Yellow Peppers, Polenta and Mozzarella on Roasted Tomato Coulis
Side Dishes: Fresh Green Beans & Carrot Medley & Oven Herbed Roasted Potatoes
Dessert:
Old Fashioned Chocolate Layer Cake
Cheesecake with Seasonal Berries
PLEASE INDICATE ON DELEGATION REGISTRATION FORM IF ANY INDIVIDUAL HAS SPECIFIC DIETARY NEEDS THAT ARE NOT MET BY THE ABOVE MENU.
Liability form - ALL individuals MUST SIGN AND COMPLETE!___________________________
This form must be completed and signed by all individuals attending the conference. This form can be completed and emailed to the conference prior to the start of conference or at conference check-in.
Gender Neutral Housing Disclaimer Form__________________________________________
Any individual interested in gender-neutral housing must complete and sign the document below, and email the document to the conference staff prior to be assigned to a gender-neutral living space. All gender-neutral forms are due no later than October 10, 2014; however, it is suggested that this document be sent prior to/immediately following completion of the registration form. If you have any questions, please feel free to contact us at any time.
Click here to register your delegation!
You will need a password to access the link. The password is: MowiiBear2014.