ASDAH: Registration Page Conference 2009

Registration Page Conference 2009

Printer Friendly

Please complete this form in full and select a payment option to finalize your conference registration. We look forward to seeing you in DC!

Hotel: you will need to make your hotel reservations separately. We will be holding the conference at the Dulles Marriot Hotel and are able to offer a discounted room rate of $89/night. Click here for a direct link to our Marriot reservations page. (ASDAH reservation code: ASDASDA)

Required *

First Name*

Last Name*

Occupation

Title/Organization

Address (mailing)*

Address (mailing - line 2)

City *

State/Province*

(Add Option = NonUs.
Canada = drop down)

Zip/Postal Code*

Country*

Phone (primary)*

(Please insert hyphens for all
phone #s, e.g. xxx-xxx-xxxx)

Phone (secondary)

Fax

E-Mail*

Confirm E-Mail*

Are you a current ASDAH Member?

Yes

Can you volunteer to help at the conference?

Yes

How did you hear about the ASDAH Conference?

Comments/Questions

CONFERENCE REGISTRATION OPTIONS:

$275 ASDAH Member Conference Registration Fee

(Includes membership renewal through June 30th, 2010.)

$295 Non-member ASDAH Conference Registration

$30 one-year NEW ASDAH membership (special conference rate)

(NOTE: Membership year is July 1 - June 30th.)

Individuals and organizations applying for membership agree to uphold the ASDAH mission (click to view) and goals, and confirm their commitment to the Health at Every Size Principles (click to view). ASDAH welcomes people of all sizes and shapes regardless of race, color, national origin, religion, creed, gender, age, marital status, sexual/affectional orientation, mental or physical disability or veteran status.

Donations: If you would like to make a donation to assist someone in financial need to attend the ASDAH conference please indicate amount of donation here:

NOTE: ASDAH is a non-profit organization classified as 501 (c) (6). Contributions, gifts, and dues to ASDAH are not tax deductible. ASDAH donations & dues may be deductible as business expenses -- please consult your tax professional.

A LA CARTE ITEMS

FOR NAAFA ATTENDEES and ASDAH MEMBERS ONLY:

- Those registered for NAAFA receive a discount on the a la carte items - ASDAH Members who plan to only attend the Saturday programming at conference can register at this rate
Please enter your NAAFA registration date:

$65 Day pass for Saturday, August 1 - includes fee for Conversations with Susie Orbach

(Note: breakfast, box lunch & Hors d'oeuvres included)

$30 Conversations with Susie Orbach only, Saturday, August 1

(Note: Hors d'ouevres included) REGISTER BY JULY 24

FOR GREATER DC AREA ATTENDEES ONLY:

The Saturday programming and guest speaker event is open to non-member local residents in the Greater DC area.

$75 Day pass for Saturday, August 1 - includes fee for Conversations with Susie Orbach

(Note: breakfast, box lunch & Hors d'oeuvres included)

$35 Conversations with Susie Orbach only, Saturday, August 1

(Note: Hors d'oeuvres included) REGISTER BY JULY 24

Total Payment

CAUTION: Please make sure this form is complete and accurate before selecting your payment option. Once you have clicked on Pay Online or Pay by Mail attempting to click your browser BACK button will result in an application error.

P.O. Box 3093 Redwood City CA 94064 ~ 877-576-1102 (toll free) ~ www.SizeDiversityandHealth.org