Registration Form
If you are registering your child or yourself, please use this form. Youths
under 18 must have a parent/guardian named on the form.
* Required Field
*
Name:
*
Address:
City, State, Zip:
Phone:
*
Parent's/Guardian's Name:
Attendee 1:
Attendee 2:
Attendee 3:
Attendee 4:
Attendee 5:
Questions, comments, or feedback:
Sponsor's Registration Form
If you are sponsoring this event for someone else, please use this form
* Required Field
*
Sponsor's Name:
*
Company:
Job Title:
Email:
Phone:
Attendee 1:
Attendee 2:
Attendee 3:
Attendee 4:
Attendee 5:
Questions, comments, or feedback:
Registration via fax will be processed immediately. Any registration form not accompanied by full payment will be considered pre-registered. To confirm
registration, registrants must have ALL MONIES IN TO CIRCLES W.O.M. NO LATER THAN OCTOBER 28, 2005. If monies are not received by October
28, 2005, registrants will not be allowed to attend the Gala, unless payment is received in full the day of the event. Registration forms accompanied by full
payment will be processed immediately. Registrants and/or attendees will receive confirmation via email, phone, fax or standard mail within two (2) to three
(3) business days. Registration forms submitted via mail must also be received by October 28, 2005, with full registration payment. For paid registrations,
cancellations must be received in writing by October 14, 2005, and a $35 processing fee will be charged per attendee. Cancellations will be processed
post-conference. No fees will be refunded after October 14, 2005. In case of substitution, submit in writing the name of the person to be substituted along with
a completed registration form for the substitute attendee. No substitution fee will be charged. After October 14, 2005, substitutions must be made on-site the
day of the event: Saturday, November 5, 2005, unless otherwise noted. Refunds are not granted for no-shows. No audio or video recording is permitted.  
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GALA REGISTRATION
Dream it, Be it * Think it, Do it * See
it, Have it!