Registration

Please complete a separate form per conference attendee. If you are registering as a couple and want to write just one check, feel free to do so; however, we ask that each of you fill out an individual registration form to help us with our record-keeping.

Information will be used only for communications with conference committee, never loaned, sold, or distributed.

Name(s):		*NOTE:* Conference attendees must be over 18 years old.
Address:
City:	State:	Zip:
Phone (days):	Phone (evenings):
E-mail:
Emergency Contact:		Phone:
Special needs (dietary, health):
*Special Bonus!* Individuals who register 5 weeks prior to the conference will receive a free T-shirt. Please indicate your size: Small Medium Large Extra Large Other: _______________________(1x, 2x, 3x)

Payment (Please mark your choices)
Conference fee per person (fee includes all -- workshops, meals & entertainment)	$48.75 regular -or- $35 senior (65+) or full-time college student -or-
	NOTE: Scholarships are available for full-time college students, persons on fixed income, and/or are on unemployment. We require a $5 registration fee enclosed.
	Scholarship requested (__ full or __ partial for $___________) If a student, enter the name of your college below:

PLEASE MAIL YOUR CHECK (payable to "Rainbow Pride Connection") AND A PRINTED, COMPLETED FORM TO:

Rainbow Pride Connection
P.O. Box 574
Chautauqua NY 14722

NOTE on cancellations: We will refund conference fees (minus $10), if cancelling one week before October 2, 2010.