To
Pre-Register for the Conference Print off and complete the following
information and mail with your check to the address below:
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CONFERENCE
PRE-REGISTRATION NAME
(S):______________________________________ (please
print) ADDRESS:_____________________________________ CITY:__________________________________________ STATE___________ ZIP
+4________________________ PHONE (Home): (_____)-_______-__________________ EMAIL:
________________________________________ PLEASE CHECK CHAPTER AFFILIATION Conference
Fees: Complete Section A or B A. FEE FOR EXISTING APC MEMBER (2003-2004 Dues
already paid to chapter) # of people ________X $20 = $__________ B. FEE FOR NEW MEMBERS (Includes 1 year Membership) (Please complete the Membership form and
sign on back) Pre-Register
One person $85 _________($90 Day of Conference) Pre-Register
Two people $105 _________($115 Day of Conference) CONTRIBUTION TO APC ...$_________ TOTAL ENCLOSED ...........$_________ (Make
check payable to APC, Inc. -
Must be received by Prior to Conference)
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APC MEMBERSHIP INFORMATION Name
1 _________________________________ Occupation
______________________________ Name
2 _________________________________ Occupation
______________________________ Pre-Adoption
or Post Adoption?______________ If
Post-Adoption:_________________________ (#
of children - Ages?) Although APC, Inc. through its members, seeks to gather information, including adoption
source data and gratuitously assists its members, neither APC, Inc., its
officers, or members, accept responsibility for those who follow any particular
channel or source in the course of adoption. I have read and understand the above
statement. (all members must
sign.) Signature 1:___________________________ Signature 2:___________________________ NOTE: All membership data is kept
confidential and for the exclusive use of APC in order to better serve
membership needs with regard to activities and discussion groups. WELCOME
TO ADOPTIVE PARENTS COMMITTEE! THANK
YOU FOR YOUR MEMBERSHIP AND SUPPORT. MAIL TO: APC/ADOPTION
CONFERENCE Pre-Registration Fresh Meadows, NY 11365-0241 |