ARCHIVAL PAGE

Conference
Registration

Name:

Mailing Address:

E-mail address:

Phone: (daytime preferred)
please include area code.

Name of College/University/H.S.:

Access:

I need wheelchair access
I have other special needs (specify):

Roommate Service:

Some registrants will have extra space in their hotel room. We are willing to try to match these people up with students who need hotel space via email. Please let us know if you want to participate in this service.

I will need a roommate for my hotel room. (please note your hotel here if known: )

I need to be matched with someone who has space in his/her room

Community Housing:

We expect to have a limited number of spaces in homes of Chicago area residents for conference registrants who cannot afford to stay in a hotel. We regret that we may not be able to fulfill last minute requests for community housing.
I need community housing (we cannot guarantee free housing space but we will attempt to meet all requests)
for Friday, February 20 Saturday February 21
I will be driving to the conference I have allergies to cats and/or dogs Non-smoking space

Mailing list:

The conference mailing list may be rented in the future to help raise revenue to support future Midwest BLGT College Conferences. An ongoing conference steering committee (now being formed) will make decisions as to who is eligible to rent the mailing list:

You have my permission to share my name and address for such mailings
Please do not share my name and address

Fees:

 $45 Regular fee
	(Registration forms mailed after February 8 may not be 
	 received before the conference. Please register by phone 
	 at (312-413-8619), by FAX (312-996-4688), or at the door.
	 You can leave your credit card number on our secure voice 
	 mail system.

	 Note: Registration at the door will not be available 
	 should we sell all 1100 spaces). You can submit this form
	 electronically and call us with your credit card number.)

  $25 Special one-day registration 
    
  $10 UIC students. Please enter your I-card number here:
     (this rate is only for currently enrolled UIC students)
     
Enclosed is my check/money order for $ payable to "OGLBC"
 Please charge $ to Credit Card #: _____________________________
	Note: For your safety, you will need to telephone or fax your credit
	card number to us. We cannot guarantee the security of your number if you
	send it us by e-mail and you risk the potential of unauthorized use should
	someone intercept it.

MasterCard       Visa       Discover

   Name as it appears on your card: 
   Expiration date: / (in month/year format)

I am attending the conference and I would like to make an additional donation of $to support the conference's efforts to keep registration fees low.

I am not able to attend the conference but I would like to make a donation of $to support the conference's efforts to keep registration fees low and to assist in the important work of the conference.

This web site does not have a secure server. You may either print and mail this form to the Office of Gay, Lesbian and Bisexual Concerns [OGLBC], fax it (if you are paying by credit card), or submit this form using the "register me" button below. Click here if you want a text-version of this form to submit via e-mail (mblgcc98@uic.edu). If you submit this information via web or e-mail, call us with your credit card number at (312) 413-8619 or fax it rather than send it over the Internet. You may also call us during weekdays and give us this information over the phone (312-413-8619).

Mail registration forms and checks/money orders/credit card # to: Fax registration forms with credit card information to:

OGLBC (M/C 369)

1007 W Harrison 4078 BSB

Chicago, IL 60607-7140
(312) 996-4688

We expect to fill all available seats at this conference. Registration will be cut off at 1100 participants (due to fire code restrictions). Please register early to avoid disappointment. Due to competing conferences, a limited number of hotel beds are available for our weekend in Chicago. Make your reservations early to guarantee your space. None of the conference hotels have discounted rooms for conference attendees at this date (our agreements expired on January 20).

When you have completed everything above:

If you need to start over again,

Please note, your information has to be converted into an e-mail message. This may take several seconds (5 to 30 seconds) so please be patient. Depending on how your browser is configured, you may also be warned that you information is not "secure." That is why we do not ask for credit card numbers on this form. Please wait for the next page which will tell you that your registration form has been delivered. Thanks!

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Conference Registration

Conference
Registration