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IC 2011 - REGISTRATION

January 31 (Eve) - February 1, 2011

CONFERENCE INDIVIDUAL REGISTRATION FORM

Name Title Parish or Org. Address City/State/ZIP Phone/FAX Email

FEES IC Registration Fee

$

Tues Box Lunch ($15 each)

$

Tuesday Dinner ($25 each)

$

TOTAL.................................

$

If a registration is cancelled a non-refundable fee of $5/PERSON will be retained in addition to the admin fee

Please list any special needs, including dietary needs:

IC REGISTRATION (INDIVIDUAL)*:

_____ Check enclosed

Full registration includes Monday evening social and Tuesday sessions

Make check payable to INTERACTIVE CONNECTIONS Mail Check and this form to:

1-2 Persons - $50/person 3-5 Persons* - $40/person 6-24 Persons* - $35/person 25+ Persons* - $25/person Tues Box Lunch 15.00 Wed/Thurs Dinner 25.00

Caroline Cerveny, SSJ INTERACTIVE CONNECTIONS 557 Dove Terrace West Oldsmar, FL 34677

15.00 25.00

* Group registration must be coordinated by

ROOM RESERVATIONS (Deadline 12/15/10) In order to be together as a group, a block of rooms has been reserved at the Doubletree Resort Orlando -International Drive, at the rate of $89.00 + TAX. To reserve your room, please contact the hotel directly. The special rate is available (3) days pre- and postconference dates. Rooms canceled after 12/21/2010 may incur cancellation fees. Note: A room reservation at the Doubletree Resort may not be available after 12/15/2011. Registration form and payment must be postmarked no later than December 31, 2010 . All cancellations and requests for REFUNDS will be subject to a $50 administrative fee and $5/person fee and must be postmarked by January 3, 2010. No refunds will be given after that date.

ONE CONTACT PERSON. Photo's may be taken during the conference to promote future IC conferences. Individuals need to notify program organizers if they do not wish to be photographed.

HOTEL INFORMATION Doubletree Resort Orlando - International Drive 10100 International Drive Orlando, FL 32821 Registration: 407-352-1100 800-222-8733 www.doubletreeorlandoidrive.com Should you have any questions or need further information, please contact Caroline Cerveny, SSJ at: 727-744-4684 or c.cerveny@verizon.net

INTERACTIVE CONNECTIONS 2011


IC Registration - Individual