NIAC: National Symposium | Participant Registration

Registration Form

National Symposium on Adolescent Catechesis
November 5-8, 2008

Participant Identity

Title:

First Name:

Last Name:

Suffix:

Organization:

Position/Role:

Mailing Address/Contact Information

Street Address:

Address (continued) (if needed):

City:

State:

Zip:

Email:

Alternate Email:

Phone:

Alternate Phone:
Type:

Arrival/Departure Information

Estimated Date of Arrival:

Estimated Date of Departure:

Housing

The National Initiative on Adolescent Catechesis will pay the cost of sharing a double room. If you prefer a single room, a cost of $42.50 per night will be charged to you.

Housing Need (please select):
I need housing for the Symposium.
I do NOT need housing for the Symposium.

Rooming Assignment—if choosing housing (please select; otherwise leave as displayed):
Not choosing housing.
I have no preference of roommate.
I prefer to share a room with:
I would like a single room. I understand that I will have to pay $42.50 per night.

If you would like to arrive early or stay later, the Conference Center at the Maritime Institute would be happy to extend your housing arrangements. Please contact them directly at 866-900-3517.

Deposit

To secure your housing, we require a $150.00 deposit. The deposit will be refunded to you upon your arrival at the Symposium. If you are unable to attend the Symposium, we must receive your cancellation 72 hours prior to the beginning of the Symposium. Cancellations made less than 72 hours before the Symposium opening will forfeit the deposit.

Payment Method (please select):
I will pay now by credit card.
I will mail a check.

For Credit Card Payments: (Please complete.)

Credit Card Number:

Expiration Month: Expiration Year:

Name as it appears on the Credit Card:

For Payments By Check:
Please print this form BEFORE hitting "Submit" and mail both the check and this form to:
National Initiative on Adolescent Catechesis
415 Michigan Avenue, NE
Suite 40
Washington, DC. 20017

National Symposium