Adult Interest
Name 1:
Email 1:
Name 2:
Email 2:
Name 3:
Email 3:
 
Address:
City:
State:
 Canada:
Zip:
 
Phone (evening):
 - -
Phone (day):
 - -
 
I am / we are (check all that apply):
LGBT Parent(s) LGBT Prospective Parent(s) LGBT Community Member(s)
Child of LGBT Parent(s) Supportive Friend / Ally Health & Human Services Professional

Potential Vendor / Resource Fair Participant
(if you choose this box you will automatically receive additional information)

 
Children and Youth Interest (12 and under)
First name 1:
Age:
Grade:
Date of birth:

month day year
First name 2:
Age:
Grade:
Date of birth:
 month day year
First name 3:
Age:
Grade:
Date of birth:
 month day year
Please list additional children and their information below:
 
I / we will require hotel accomodations for:
Friday night, April 24, 2009
  Single (king-size bed)
  Double (two double beds)
Saturday night, April 25, 2009
  Single (king-size bed)
  Double (two double beds)
 
Please share your ideas about adult programs you would like to see at the Conference (workshop topics, speakers, etc...):
 
Please share your ideas about the children's programming you'd like to see:
 
Ideas for family activities? Entertainment?
 
We plan to host a resource fair as part of the Conference. Do you have suggestions for companies, organizations or individuals to invite to participate?
Thank you for your RSVP!