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National Black Lesbian Conference
April 7-10, 2005
Dallas Texas
Hilton Dallas Lincoln Centre |
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ONLINE REGISTRATION FORM
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Complete a separate form for each individual. Note: Nametag will be produced from information provided below.
Conference registration fee includes workshops, plenary sessions, forums, brunch, banquet, and networking sessions.
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First Name:
Last Name:
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Address:
Suite/Apt:
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City:
State:
Zip:
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Email:
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Telephone:
Fax:
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Payment Information
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On-line registration only until April 4, 2005: $175.00
Online Payments accepted until April 4, 2005.
Submit your payment via PAYPAL.
No MAIL-IN registrations after March 25, 2005.
On-Site Registration is $250.00 beginning April 7, 2005.
NO CREDIT CARD PAYMENTS ON-SITE.
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Services Requested:
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Sign Language Interpretation
Wheelchair Access
Vegetarian Meal
Other:
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Cancellation Policy: If you register and are unable to attend you can donate your registration to the scholarship fund. Refund request must be in writing by February 7, 2005 to receive a refund. A check will be issued with 15 days. Cancellations received in writing after February 7, 2005 but before March 7, 2005 will be refunded after the conference with a 25.00 processing fee.
Refund request after March 7, 2005 will not be refunded.
Zuna Responsibility: Zuna Institute will not assume responsibility for theft, loss or damage of personal property, or injury occurring in any of its programs and activities.
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