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statue Shedding Light on the Adoption Experience, VI
An Educational Conference about Realities:
The Lifelong Effects of Adoption and
 the Need for Family Preservation

September 24-25, 2010
Park Central Hotel
New York City
 Registration Form

We need many volunteers for hospitality, registration, book room, etc. 
Volunteers will get 1/2 day of conference free for each half day they work.
Email us for details

 Name: Mr.  Mrs.  Ms    First:  Last:
Street:        Street 2 :
City:   State/Prov.:  Zip:  Country:
Home Tel.:     Bus. Tel.:      E-mail: 
Confirm E-mail:   I am:  Adoptee   1st Parent   Adoptive Parent 
Mental Health Professional                      Other  
**  It would be a kindness to use the term "Mother" or "First Mother"
 during this conference, as opposed to using the "birth" prefix.
(An increasing number of mothers of adoption loss experience these prefixes as oppressive). Thank you!
INSTRUCTIONS:  Click the circle next to the
appropriate  fees & fill in the payment information.		 Before May
 5/01 - 7/01
 7/01 - 9/01
 After 9/01
 
Full Conference Registration:
 Includes admission to Plenary Sessions,
 2 days of seminars, Exhibit Hall, Support Group
Nightly Hospitality Suite, Saturday Evening Banquet.

**Student fee - Banquet not included		 175



50
 200



75
 240



100
 280



125
One Day Conference Registration:
 Includes 1 day Plenary Sessions, 
]seminars, Exhibit Hall, Reception
Support Group, Hospitality Suite
**Student fee

Select Day Friday     Saturday
100



30
 125



40

 145



60
170   


75         
Saturday Evening Banquet & Entertainment
 100
  100
 100
 100

Comments  (max 2,000 chars, aprox 200 words)



Payment Information            (Payment must be payable in US Funds)
Total Amount of payment:             Name on Card: 
Payment By: Card No. Card Exp
Security Code   What is the security code?

** Students must send verification of full-time status (copy of registration) for fall of 2010
 or letter of acceptance to degree-granting program in the mental health field.
Adoption Crossroads and Adoption Healing are not responsible for changes in speakers or seminars.

*** You must complete the Seminar Selection Form below.
Seminar Selection:  List your choices below:   Seminars are assigned on a first-come, first-served basis.
             
                          Friday                          Saturday        

 Set 100 Fri  AM
    Set 200 Fri PM
  Set 300 Sat AM 
 Set 400 Sat PM   
  1st  Choice
  2nd Choice

Refund policy:  Requests must be made in writing and postmarked by 9/1/06 and are subject to a $50 service charge aside from the banquet fee.  After 9/1/06, refunds will be made for serious medical emergencies and ONLY If postmarked by 09/06 and subject to a $75 service charge aside from the banquet fee.  All refunds will be processed after the conference.

Your registration maybe submitted by pressing the Send Form button below
 or Printed out and mailed or faxed to us.  Each person must submit a separate form.

Please press the SEND button

For  more information  call 845-268-0283 or
send E-mail to us at conference@adoptionhealing.commailbox

Adoption Healing
74 Lakewood Drive
Congers, NY 10920
845-268-0283

 Updated on March 19, 2009 by Joe Soll