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ONLINE REGISTRATION CLOSED. REGISTER DAY OF AT CONFERENCE
RequiredRequired Question(s)

 

REGISTRATION CLOSED.  PLEASE REGISTER DAY OF AT THE CONFERENCE!

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TRANSGENDER LIVES The Intersection of Health and Law Conference 2010 Registration Form. 
This form can also be used to sponsor the conference, have an ad in the conference program book, table at the conference, make a donation or provide support for conference scholarships.

If you experience problems, or prefer completing a word or pdf Registration/Sponsorship form and pay by check then go to the TransgenderLives.org website and all forms are on the upper left hand side of website. Conference is to be held on April 17, 2010 from 8 AM till 5 PM.  See website for details.

For further information call (860) 983-8139 or send an email to conference@transadvocacy.org

 
Required 1.

Please enter the information requested below.


First Name:
Last Name:
Company Name:
Work Phone:
Home Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

Note: If you have previously registered and using this form to sponsor, advertise, table, and/or make a donation then go directly to question 11 from here.

 
2.

Preferred name for conference badge. Otherwise we will use name provided in question one.

 

50 characters left.
3.

Agency/Organization (if applicable)

 

50 characters left.
4.

Registration Type (No one will be turned away due to cost).

$25 Individual
$50 Agency
Requesting Scholarship if you cannot afford Individual registration cost (limited number of scholarships available)
Sponsorship Registration (see Sponsorship details under Question 11 below)
5.

Method of Registration Payment:

Upon completion of this registration you will be taken to a page to make a secure credit card payment via TransAdvocacy's Paypal account. If prefer to pay by check then Mail all checks to TransAdvocacy, PO Box 111, Farmington, CT 06034 and please make checks payable to CTAC. If you need to pay by cash, please make a note under comments and please contact us directly to arrange logistics. Questions regarding payment can be directed to either (860) 983-8139 or conference@transadvocacy.org

Pay by Paypal
Pay by Check
Requested Scholarship (limited number of scholarships available)
This Registration Payment included in Sponsorship package
Pay by Cash
  • Comment:

  • 500 characters left.
6.

Deadline for Lunch selections has passed.
However the UCHC cafeteria will be open.

Closed
Closed
Closed
Closed
  • Comment:

  • 500 characters left.
7.

Interpretation Now Closed
Interpretation Needs (Please respond by 3/15)

CLOSED Sign
CLOSED Spanish
  • Comment:

  • 500 characters left.
8.

Special Needs not noted above?

 

350 characters left.
9.
Transportation
I need transportation
I can provide transportation
10.

I would like to Volunteer to help make the 2010 Transgender Lives Conference a success!

Volunteer with Conference organizing prior to day of
Volunteer on day of
  • Comment:

  • 500 characters left.
11.

I would like to make a Donation and/or Scholarship Contribution to the Conference (please indicate amount in Comments section).

Donation for Conference
Contribution for Conference Scholarships
  • Comment:

  • 500 characters left.
12.

Sponsorsip Now Closed
I would like to be a Sponsor of the 2010 Transgender Lives Conference.

Silver: $250-$499 (Includes exhibit table, display your banner, 1/2 page ad, 2 registrations)
Gold: $500 and up (includes exhibit table, display your banner, full page ad, 4 registrations, promotional material in attendee's packets [material must be provided])
13.

Ads Now Closed
I would like to place an ad in the 2010 Transgender Lives Conference Program Book.

$30: 1/8 page/Business card size
$50: 1/4 page
$90: 1/2 page
$175: Full page
$250: Covers (Inside front, inside back and outside back)
14.

Promotional Materials Now Closed
I would like to table and/or have promotional material made available at the 2010 Transgender Lives Conference Program Book.

$150: One table for exhibiting at Conference (Table space is limited so sign up early)
$50: Promotional material can be inserted into attendee packets (requires an ad be purchased and all materials must be provided)
15.

Method of payment for Donations/Scholarships/Sponsorship/Ad/Tabling/Promotional materials? [See Question 5 for  Registration Payment Method]

Upon completion of this registration you will be taken to a page to make a secure credit card payment via TransAdvocacy's Paypal account. If prefer to pay by check then Mail all checks to TransAdvocacy, PO Box 111, Farmington, CT 06034 and please make checks payable to CTAC.  If you need to pay by cash, please make a note under comments and please contact us directly to arrange logistics. Questions regarding payment can be directed to either (860) 983-8139 or conference@transadvocacy.org

Pay by Paypal
Pay by Check
Pay by Cash
  • Comment:

  • 500 characters left.