NOLOSE 2006 Registration

Sorry, the discounted earlybird rates and Financial Assistance funds have expired. 

Please register each person individually. If you would like to pay for multiple registrants together, please pay by check (instructions below).  You may download and send in a print version with payment, if preferred.

To make payment online (via Paypal), please expect an additional $10 fee per registration to cover online processing fees costs. (There is no fee to register online and send payment by mail.)

Please note: we are no longer receiving Financial Assistance applications, as our available funding has been spent.

(* fields are required)

Your contact info:
First name *
Last name *
Address *
Address, con.
City*
State/Province*	Select option U.S.: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming ------------------ Canada: Alberta British Columbia New Brunswick Newfoundland Northern Mariana Is Northwest Territories Nova Scotia Ontario Prince Edward Island Province du Quebec Palau Saskatchewan Yukon Territory ------------------ Other/does not apply
Zip code *
Country*	Select option United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antartica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia Botswana Bouvet Island Brazil Brune Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo(formerly Zaire) Congo, Democratic Republic of Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Vatican City Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, North Korea, South Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovak Republic Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uraguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Yugoslavia Zambia Zimbabwe Other _______________________________________
Primary phone *
Secondary phone
Fax
Email *
I’m not on the nolose-announce e-mail list. Please add me!
How did you hear about NOLOSE?
Conference registration:
Food preference*	regular vegetarian vegan
Registration rate and room type *	Please select rooming option and rate: -------------------------------------- A1 - PRIVATE BATH, QUEEN BED, SINGLE-OCCUPANCY        A1 - Doing well: $700        A1 - Doing okay: $675        A1 - Doing not-so-great: $650 A2 - PRIVATE BATH, QUEEN BED, DOUBLE-OCCUPANCY        A2 - Doing well: $525        A2 - Doing okay: $490        A2 - Doing not-so-great: $465 B - PRIVATE BATH, 2 SINGLE BEDS, DOUBLE-OCCUPANCY        B - Doing well: $525        B - Doing okay: $490        B - Doing not-so-great: $465 C2 - SUITE, PRIVATE BATH, DOUBLE-OCCUPANCY        C2 - Doing well: $550        C2 - Doing okay: $525        C2 - Doing not-so-great: $500 C3 - SUITE, PRIVATE BATH, TRIPLE-OCCUPANCY        C3 - Doing well: $475        C3 - Doing okay: $450        C3 - Doing not-so-great: $425 D - SHARED BATH, 2 SINGLE BEDS, DOUBLE-OCCUPANCY        D - Doing well: $475        D - Doing okay: $450        D - Doing not-so-great: $425 E - DORM HOUSING, 2-3 PER ROOM, MULTIPLE OCCUPANCY        E - Doing well: $450        E - Doing okay: $425        E - Doing not-so-great: $400 F - CAMPING (INDOOR/OUTDOOR)        F - Doing well: $350        F - Doing okay: $325        F - Doing not-so-great: $300
View room chart. There are limited rooms available for each room type, so priority is given on a first-come, first-served basis.
Important: please name anyone you’ve coordinated to share a room, suite, or dorm with so we know to assign you to the same room:
Additional room options
Do you require a wheelchair-accessible shower?
Do you require a room with no stairs? (Some bldgs. have stairs to 2nd floor)
Do you require a phone in your room? (Credit card deposit due to Menla on check-in; charges for use will apply to your card.)
I support NOLOSE! I want more fab folks at the conference! >> Donate to the Julia Carson Heart of Gold Fund (assistance for low income community members) U.S. $ >> Contribute to the NOLOSE general fund. U.S. $
Total (reg + donations) *	Please remember this amount for the next page! U.S. $
Comments/instructions
Method of payment *	Paying by check (postal). Paying by credit/debit card/online check(Paypal)
(Skip ahead to the bottom if you're paying by check or credit/debit and are ready to send this baby in!)

Applying for Financial Assistance:
We're no longer accepting FA applications; our available funds have been committed and spent. Close to 50% of the folks who have applied are receiving some form of financial assistance. We're sorry there's not more to go around, but need the help of dedicated volunteers to help with fundraising to make that happen.
	Please click only once! It may take a moment to process:

Cancellation policy: refundable in full (minus any online Paypal fees) on cancellations through July 31. After Aug. 1, we can only refund 75%.

Questions? Contact reg@nolose.org.