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WSRD Conference Registration Form

Registration Deadline: March 3, 2003

Participant Information (Please print clearly.)

Name:
Title:
Name you prefer on badge:
Organization:
Address:
City:	State:		Zip:
Phone:	Voice	TTY
Fax:	Email:
Workshop Accommodations Please indicate the accommodations you need for attending workshop sessions (e.g., assistive listening devices, Braille, close-vision interpreting). Deadline for making requests March 3, 2003. (Note: Accommodations for your hotel room should be requested from the hotel.)
Sign Language Interpreters (Platform)	Yes	No
Realtime Captioning	Yes	No
Assistive Listening Devices	Yes	No
Braille	Yes	No
Close Vision Interpreter	Yes	No
Tactile Interpreter	Yes	No
Other (Please describe):
Meals Several meals are included in the conference registration fees. To help us with our meal count, please indicate if you plan to attend the following:
Wednesday Box Lunch	Yes	No
Wednesday Evening Reception	Yes	No
Thursday Luncheon with Plenary	Yes	No
Friday Luncheon with Plenary	Yes	No
Vegetarian meals:	Yes	No

$250      Conference Fees (Wednesday, Thursday, Friday)
                    (includes Conference Sessions Wednesday, Thursday and Friday;
                    no-host reception Wednesday; continental breakfasts; and lunches)
$200      Student Registration (also includes meals and reception)
               For full-time graduate or undergraduate students only.
               Faculty signature (required): ___________________________
               School and Department: _______________________________
$275      Late Registration (After March 3, if space is available.)

______ Total Amount Enclosed (Check, Money Order, or Purchase Order)

Please make checks to: Regional Resource Center on Deafness/Western Oregon University

Mail completed registration form and payment to:

Regional Resource Center on Deafness
Western Oregon University
345 N. Monmouth Ave.
Monmouth OR 97361
ATTN: Becky Graber