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The 14th Annual National ADODI Summer Retreat
2000 ADODI National Summer Retreat Registration Form
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Name:
__________________________________________________
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E-Mail:
_________________________________ |
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Address:
________________________________________________
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Day Phone: (_____)
______________________ |
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City: ______________________ State
_______ Zip ____________
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Eve. Phone: (_____)
______________________ |
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Enclosed you will find my [ ] $200.00 Registration Fee (Before 6/1/00)
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[ ] Partial Payment of $_____________
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Enclosed you will find my full $250.00 Registration Fee (After 6/1/00)
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Do you have any dietary restrictions? Yes [ ] No [ ] If Yes, what?
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_______________________________________
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Do you have any physical restrictions? Yes [ ] No [ ] If Yes, what?
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_______________________________________
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Is this your first ADODI Retreat? Yes [ ] No [ ] How did you hear bout the retreat? ____________________
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Would you like to purchase a retreat:
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[ ] T-shirt for $10.00 Size: ________ [ ] Crew Neck [ ] Tank Top
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(Enclose payment with registration fee)
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[ ] Cap for $6.00 (One Size Fits All)
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Would you like to make a contribution to the scholarship fund? [ ] No [ ] Yes Amount Enclosed $____________
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Due to
limited space, Early Registration is strongly advised. Fees are transferable but
non-refundable. |
| Please return this form and make check or
money order payable to: |
| ADODI Chicago |
| P. O. Box 3555A, Chicago, Illinois 60690 |
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