Victim Impact Panel Stearns County – St. Cloud, MN 56301 First Name* Middle Name* Last Name* Date of Birth* Phone* Email* Sentencing County* Panel Dates: January 10th February 14th March 14th April 11th May 9th June 13th July 11th August 8th September 12th October 10th November 14th December 12th LOCATION: MADD does not waive fees St. Cloud State University Atwood Memorial Center Theater PANEL TIMES: Sign in 1:00 – 1:55 PM th 720 4 Avenue S St. Cloud, MN 56301 Panel begins 2:00 – 4:00 PM If you are late, you will NOT be admitted. FEE POLICY: REGISTRATION: Panel Fee: $50.00 (Money Order or Cash) We do NOT accept checks or credit cards Payment will be collected at the panel. BY PHONE: 320-203-7306 ONLINE: http://www.madd.org/mn I have read and noted the LOCATION, TIMES, AND FEES above that are associated with this panel: YES **MUST READ** IF SUBMITTING THIS FORM VIA MAIL WE MUST HAVE THIS FORM IN OUR MAILBOX AT LEAST ONE WEEK PRIOR TO THE VICTIM IMPACT PANEL. IF SUBMITTING THIS FORM VIA EMAIL WE MUST HAVE THIS FORM IN OUR E-MAIL BOX AT LEAST 3 DAYS PRIOR TO THE VICTIM IMPACT PANEL. If the panel you sign up for is full by the time this form is emailed or mailed to us we will call the number on this form and verify that you are NOT signed up for the date requested due to the panel being closed. If you fail to mail or email us this form with the proper advance notice you will not be signed up for the panel** This message is only for those who do not sign up online or via the phone. PLEASE READ IMPORTANT PANEL INFORMATION • No Alcohol or drug use prior to attendance • If you are suspected of using alcohol or drugs, law enforcement will be called. • If you choose to or are asked to leave at any time during the presentation, you will not be readmitted and will not be refunded the $50 fee. • No children under the age of 16 will be permitted to attend without a parent or guardian. • At the conclusion of the panel, you will be given a verification of attendance. • You must retain and provide a copy to probation, court admin or any agency in reference to your case. • Failure to provide proof may result in additional consequences. • Weather cancellations will be posted on the panel registration line and local news stations. I have read the information* YES