Name: ___________________________________________
Mailing Address:___________________________________________
___________________________________________
E-mail address:___________________________________________
Phone: (daytime preferred/include area code) _______- __________________
Name of College/University/H.S.:___________________________________________
Access:
___ I need wheelchair access
___ I will need an ASL interpreter
___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.
(note your hotel 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.
___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
___I need a non-smoking space
Day care:
We are exploring the possibility of offering day care for children of registrants during daytime and early evening sessions. We cannot guarantee that this will be an option. Insurance requirements may be prohibitive.
___I would use day care services for my children if they were available
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:
___Postmarked by February, 8, 1998: $40
___At the door: $45
(registration forms mailed after February 8 may not be received before the conference. Please register at the door).
Enclosed is my check/money order for $______ payable to "OGLBC."
Please charge $______ to my Credit Card #:_________________________________
___MasterCard ___Visa
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.
You may print and mail this form (or fax it if you are paying by credit card).
Mail to:
You may also submit this form via e-mail (oglbc-2@uic.edu). If you use e-mail, we VERY STRONGLY urge you to leave your credit card number blank and call us with that information at (312) 413-8619 rather than send it over the Internet. E-mail is not secure and your number could be intercepted. You risk unauthorized use of your credit card if you send the number out via email.
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. We also have a limited number of
hotel beds reserved. Make your reservations soon to guarantee your space
(hotel information is on the web site). Our holds on these rooms expire
on January 20.
For additional information, please see our conference web site at:
http://www.uic.edu/depts/quic/mblgtcc/
or call UIC's Office of Gay, Lesbian Bisexual Concerns at (312) 413-8619.