Office Use Only
ID#
Date Received:
/
/
CHK or MO #
Receipt Sent?
Add to Spreadsheet?
23rd Biennial Convention of
INITIAL
July 23-26, 2015
in Madison, Wisconsin
Your Information
Method of Reciept (check One)
email
u.s. mail
(Please Print Clearly)
Name:
(include stamped self-address enevlope)
Bringing children under 18yrs old?
Yes (How Many?
)
No
Child Care? Yes
No
Saturday Banquet Dinner Choice (Check
Prime Rib
Salmon
Address:
City:
State:
Zipcode:
Well-Done
Phone:
Email:
Rare
dijon butter
Want Special Tours?
EARLYBIRD
Please read the other page before selecting
P l e a s e s e l e c t O N L Y w h a t y o u n e e d . r e c e iv e d b y
(If you want combo, select ONLY Full combo.)
12/31/2014
Full combo Package
Registration Fee (Required)
Thursday Day Event
Medium
citrus butter
cranberry butter
Need Info Booth?
Church:
r e c e iv e d b y 04/30/2015
Yes
No
Yes
r e c e iv e d b y 06/15/2015
Total
AIR
$ 165.00
$ 175.00
$ 185.00
$
$
15.00
$
15.00
$
15.00
$
15.00
$
$
20.00
$
25.00
$
30.00
$
35.00
$
Car
$
65.00
$
Bus
Enter the amount in the “total” column, then add your total here >>
$
90.00
$
$
55.00
$
$
40.00
$
$
30.00
$
45.00
(See Convention Info)
Traveling by
$ 155.00
$ 50.00
$ 55.00
$ 60.00
Friday Day Event
$ 75.00
Saturday Day Event
$ 80.00
$ 85.00
$ 40.00
Sunday Day Event
$ 45.00
$ 50.00
Luncheon for God’s 1000 Members (optional)
Add
ILDA Membership (if you wish to become a member of ILDA)
Add
OR
non-ILDA Member (if you are not a member of ILDA)
Add
Donations for ILDA only (optional)
No
Transportation
FINAL CALL
r e c e iv e d b y
02/28/2015
One)
Flight Info?
Which AIRPORT?
Which Terminal?
Other
Need Shuttle?
Yes
No
Accommodation Request?
$
$
Grand Total $
by Signing, I have confirmed I have read the registration policy, Payment and Convention information. I am aware of the Cancellation/Refund Policy.
Signature:
Date:
Registration deadline June 15, 2015
23rd ILDA Biennial Convention
Registration Policy
Payment Information
You can pay by check, money
order or cashier’s check by
mail or PayPal in US dollars.
Convention Information
Tours
Special Tours currently have a
Green Bay Lambeau Field tour on
Tuesday, July 22, 2015 based on
total availability of attendees. If
interested,
please
check
on
Registration deadline
June
15,
2015
C o m b o T i c k e t i n c l u d e s registration form. Or any questions,
in order to register,
please
- Registration
feesend:
please
contact
Jeff
Padon
at
- admission to all meetings and workshops
410-608-8053
VP.
banquet/entertainment
1) a registration form - Program Book
Local Tours will be announced at
(use one form for each person)
if you need to transfer the ticketwww.ilda2015.com.
to another
please notify us at
2) Your payment member,
r othe
w ne Plaza H otel
[email protected] asapcfor
check, money order
orrequest.
cashier check
change
This hotel has a block of rooms
reserved for our attendees at
payable to
group rate of $109.00/per night
OSLDC - ILDA 2015
in
all
types
of
rooms
at
your
own
expenses.
(families may combine all payments on one check,
money order or cashier’s check)
The
room
can
be
booked
online
at www.ilda2015.com and look for
3) If you want a reciept, enclose one
Book Hotel link or contact hotel
stamped self-addressed enevelope.
at
608-244-4703
and
use
this
group code “International
4) Mail to this address below
Lutheran
Deaf
Association”.
ilda 2015 madison
More information about the hotel
can be found at
c/o dawn polzin
www.cpmadisonhotel.com.
512 femrite drive #16
O ther H otels
Monona, WI 53716
If you want to stay at a different
C a n c e l l a t io n s & R e f u n d s P a y P a l M e t h o d
hotel in the area, get more info
for combo tickets, cancellations
from our website at
will be accepted but refunds are
You may use PayPal to make a payment,
www.ilda2015.com.
You
will
be
given in full before Feburary 28th,
please use this email address to make
responsible for your own
2015, 50 percent refund before
the payment to
transportation between your hotel
April 30th, 2015 and no
[email protected]
and the convention.
cancellations and/or refunds will
and make sure you add 3% to your
be given after May 1st, 2015.
R estaurants
there will be no refunds given for
total payment when sending a payment
The meals that are not included in
any individual day tickets.
through PayPal. Scan your completed
the convention. There are many
restaurants nearby which can be
B adges
registration form and email to
found
listed
at
You will be expected to use your
[email protected] for
www.ilda2015.com.
badge throughout the conference.
processing your registration.
W
e
b
s
i
t
e
S chedule
A n y q u e s tio n s , p le a s e c a ll r
website
for
any
further
Check
ou
We reserve the right to modify the
Dawn Polzin at 608-234-4674 information
about
this
convention.
schedule, and make programming
or w
w
w
.ild
a
2
0
1
5
.c
o
m
changes.
Gregory Werth at 713 893-5138
E v e n t s I n f o r m a t io n F u ll C o m b o - Includes
All days listed below and the
registration
Fee.
T h u r s d a y - Includes
Reception
/
Social
Night
F r id a y - Includes Breakfast, meetings, Snacks, and
Workshops
S a t u r d a y - Includes
Breakfast, all day workshops and
Banquet
S u n d a y - Includes
Breakfast
and
Worship
All of these above tickets include a Program
Book per persion.
O p t io n a l -
Luncheon for God’s 1000 is for
Friday only at Noon to support our
officers’ expenses
d o n a t io n s - This money will be used solely for
ILDA’s expenses