Registration Form, 50th Anniversary of the
National Council of the Churches of Christ in the U.S.A.!
November 9-12, 1999, Cleveland, Ohio

Please print out, complete and send this registration form with payment to:

50th Anniversary Celebration
National Council of Churches
475 Riverside Drive, Room 630
New York, NY 10115-0050

Please print or type!

PERSONAL INFORMATION

TITLE (Circle all that apply):
Mr. / Mrs. / Ms. / The Rt. Rev. / Bishop / Archbishop / The Rev. / Other _____________

First Name: _______________________________________________________________
Middle Initial: _______________________________________________________________
Last Name: _______________________________________________________________
Suffix: _______________________________________________________________

Organization: _______________________________________________________________
Address: _______________________________________________________________
City, State/Province, Zip/Postal Code: ___________________________________________
Country: _______________________________________________________________

Telephone: _______________________________________________________________
Fax: _______________________________________________________________
E-Mail: _______________________________________________________________

Emergency Contact Name: ___________________________________________________
Telephone: _______________________________________________________________

SPECIAL NEEDS (Circle all that apply):
Do you have any special dietary requirements? / Disability requiring special services?
If so, please explain:

 

CONFERENCE ENROLLMENT OPTIONS.  Please choose either Column One - Full Conference Enrollment or  Column Two - Daily Registration

___ Either ...
Column One- Full Conference Enrollment

A. ___ $120 fee if paid by October 1, 1999,  $140 after October 1

Includes entry into one morning and one afternoon forum (November 9-12), Anniversary Welcome Luncheon (Tuesday, November 9) and Cleveland Orchestra "Inspiration in Music" (Tuesday November 9). 

NOTE:  SEPARATE REGISTRATION/PAYMENT REQUIRED FOR ANNIVERSARY BANQUET (Thursday, November 11), CAUCUS AND SPECIAL EVENTS -- SEE BELOW.

Choice of forums - List forum number for your first and second choices:

Tuesday morning, November 9:
First Choice:
Second Choice:

Tuesday afternoon, November 9:
First Choice:
Second Choice:

Wednesday morning, November 10:
First Choice:
Second Choice:

Wednesday afternoon, November 10:
First Choice:
Second Choice:

Thursday morning, November 11:
First Choice:
Second Choice:

Thursday afternoon, November 11:
First Choice:
Second Choice:

Friday morning, November 12:
First Choice:
Second Choice:

___ $50 Anniversary Banquet, Thursday, November 11

B. Please also register me for the following events:

CAUCUS EVENTS
___ ($20) Women's Caucus Luncheon, Wednesday, November 10
___ ($20) Indigenous Caucus Dinner, Wednesday, November 10
___ ($20) Lestian/Gay/Bisexual Caucus Breakfast, Thursday, November 11
___ ($20) Racial/Ethnic Caucus Luncheon, Thursday, November 11

SPECIAL EVENTS:
___ ($20) Environmental Justice Tour, Tuesday, November 10
___ (Free) EPRUS/AmeriCorps Service Event, Wednesday, November 11
___ (Free) CROP WALK, Wednesday, November 11

TOTAL FEE: $ _________________

 ___ Or ...
Column Two - Daily Registration

Early registration, by October 1, 1999, $25 per forum; $35 for forums which include lunch.  After October 1, 1999, $45 and $55 respectively.  You may attend two forums per day, Tuesday through Thursday, and one forum on Friday.   For forums, please list numbers for your first and second choices.  Other events/fees as indicated:

A. 50th Anniversary Program Registration

Tuesday, November 9:

___ Morning Forum
First Choice:
Second Choice:
___ Fee

____ Afternoon Forum
First Choice:
Second Choice:
___ Fee

___  ($20) Anniversary Welcome Lunch

___  ($25) Cleveland Orchestra  "Inspiration in Music)

Wednesday, November 10:

___ Morning Forum
First Choice:
Second Choice:
___ Fee

___ Afternoon Forum
First Choice:
Second Choice:
___ Fee

Thursday, November 11:

___  Morning Forum
First Choice:
Second Choice:
___ Fee

___  Afternoon Forum
First Choice:
Second Choice:
___ Fee

___  $50 Anniversary Banquet

Friday, November 12:

___ Morning Forum
First Choice:
Second Choice:
___ Fee

B. Please also register me for the following events:

CAUCUS EVENTS
___ ($20) Women's Caucus Luncheon, Wednesday, November 10
___ ($20) Indigenous Caucus Dinner, Wednesday, November 10
___ ($20) Lestian/Gay/Bisexual Caucus Breakfast, Thursday, November 11
___ ($20) Racial/Ethnic Caucus Luncheon, Thursday, November 11

SPECIAL EVENTS:
___ ($20) Environmental Justice Tour, Tuesday, November 10
___ (Free) EPRUS/AmeriCorps Service Event, Wednesday, November 11
___ (Free) CROP WALK, Wednesday, November 11

TOTAL FEE: $ _________________

PAYMENT INFORMATION

Payment (in U.S. dollars) must accompany your completed registration form. 

Please make your check or money order payable to "NCC 50th Anniversary Meeting."

For credit card users, please complete the following:

Choose One:
___ Visa
___ Master Card
___ American Express

Name as it appears on credit card:

Card Number:
Expiration Date:

Cardholder's Signature:
Date:

TOTAL $$$ AMOUNT ENCLOSED ___________

DEADLINES: Early Registration for 50th Anniversary Celebration Events: Mailed registrations must be postmarked prior to October 1, 1999.  All early registrations must be received by October 8, 1999.  After that and on site in Cleveland, the higher fees apply.

CONFIRMATION NOTICE: Upon receipt of your paid 50th Anniversary Celebration registration, we will send you a confirmation notice.  If, within 30 days of the event, you have not received this information, please call 1-800-328-NCCC (code 1999).

CANCELLATION POLICY: Refund requests must be received in writing by mail or fax (212-870-3454).  A $15 processing fee will be charged for all cancellations, regardless of reason.  Written cancellations received by September 15, 1999, entitle registrant to a full refund, less the $15 processing fee.  After October 8, 1999, refunds are not available.

HOTEL RESERVATIONS: All hotel reservations must be made directly with the 50th Anniversary Celebration Housing Bureau.  A block of rooms is reserved at selected downtown Cleveland hotels.  Click here for on-line housing information and reservations!

FOR NCC USE ONLY:

Name:

Date Received:
Confirmation Date:
Refund Date/Amount:

NCC Staff: Departmental accounting unit to be charged:

$ Amount:

Credit:
1-2-4935-49354-01-30-701305 - $ _______
1-2-5600-56002-01-30-701305 - $ _______
1-2-5600-56002-02-10-702100 - $ _______
2-2-5600-56002-32-20-732204 - $ _______

Return to Registration Info Main Page

National Council of Churches—50th Anniversary
475 Riverside Drive, Room 630
New York, NY 10115-0050
Phone: 1-800-328-NCCC (Code: 1999)
Fax: 212-870-3454
E-mail: 50th@ncccusa.org