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Conference Registration August 4-7, 2005 |
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Conference Registration August 4-7, 2005 |
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Print this Registration Form and Mail it to
NDE A deposit of at least $25 must accompany this form. Each person should fill out a separate form. Hard copies of the form may be requested by calling the Nevada Desert Experience Office at 702.646.4814. A $15 discount will be given to those whose registration is postmarked before June 15, 2005. Early registration is encouraged. Registration Discounted Registration with registration postmarked before June 15, 2005 $130_____ Registration (after June 15, 2005) $145_____ Housing Please circle the night(s) you will need accommodation. Thursday Friday Saturday Single Occupancy (per night) $45/night _______ Double Occupancy (per night) $30/night _______ Sleeping bag space (per night) (available on a limited basis) $10/night _______ commuter? Yes ____ No____ Meals 9 meal package (Thurs – dinner, Fri – 3 meals, Sat – 3 meals, Sun – breakfast and lunch) $60____ 8 meal package (Fri – 3 meals, Sat – 3 meals, Sun – 2 meals) $52 ____ 6 meal package (Fri – dinner, Sat – 3 meals, Sun – 2 meals) $40 ____ 5 meal package (Sat – 3 meals, Sun – 2 meals) $33 ____ Scholarship Fund Donation To help those with limited income to attend $______ Total amount due $______ (at least $25 must be sent) Total amount enclosed $______ Additional information Roommate preference __________________________ I prefer vegetarian meals Yes ____ No____ Mobility challenged Yes ____ No____ Wheelchair accessible accommodations needed Yes ____ No____ Please check here if you will provide your own transportation to the Nevada Test Site on Saturday evening, August 6. ______ Name: _____________________________________________________________ Address: ___________________________________________________________ City/State/Zip ________________________________________________________ Home Phone: ____________________ Work Phone: ______________________ email: ____________________________________________________________ Best way to reach you: ______________________________________ Return to: Nevada Desert Experience PO Box 46645 Las Vegas NV 89114-6645 702.646.4814 (phone) nde_august@peacenet.org |