QUIP 2010 Writers' Conference and Annual Meeting Registration Form

Dates

Arrival date:

Departure date:

Contact information

Name: *

Email:

Address: *

Home phone:

Work phone:

Mobile phone:

Organization (if any):

Travel Plans

I will arrive by:

Airline information

Arrival

Airport:

Airline:

Flight number:

Time:

Departure

Airline:

Flight number:

Time:

Local Travel

Room in your car?: I have room for others

I need a ride to and from Quaker Hill Conference Center (please plan to help share this expense) :

Other travel information:

Housing plans

I have agreed to share with:

Commuter:

Yes

I have off-campus housing.

Food requirements

Dietary preference:

Other dietary needs:

Comments and questions

Please submit any comments or questions you may have:

Please suggest any topics for networking :

Scholarship Help:

I wish to donate to enable youth to attend this conference.

I need scholarship help; please contact me to discuss the amount available.

You can make your donation as part of your conference fees. (If we are confused about your total figure, we will contact you.)

QUAKERS UNITING IN PUBLICATIONS