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Lodging

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  • We recommend that a Faculty or Staff advisor accompany each student group.
  • Each group should select one member to act as coordinator for the group and indicate below.
  • The registration fee of $25 per person will include snacks and entertainment Friday evening as well as catered lunch on Saturday.
  • For those who register after Monday, October 22, the fee will be $35 per person.
  • No registrations will be accepted after October 29.
  • All funds must be received no later than Monday, October 29, 2012, at 5:00PM. Reservations not paid in full will be cancelled.
  • Cancellation for an attendee/group after Monday, October 29, 2012 at 5:00PM will forfeit any refund.
  • Checks should be made payable to: LGBTA Conference.

Please mail checks to:

Deb Chamberlain
121 Columbia Hall
Bloomsburg University
400 East 2nd Street
Bloomsburg, PA 17815

Registration Form
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Name of Institution

Academic Status/Relationship as of Fall 2012

Major or Department

Name of Club/Organization

Position within Organization (President, Advisor, Chair, Member, etc.)

Group relationship:
(or paying separately from my group)

Dietary needs:


   
If you need to make changes to your registration after submitting, please notify us by e-mail: LGBT@bloomu.edu
   
 
This page last updated August 29, 2012
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