Registration Form
Strengthening Black Families for a New Millennium
A National Family Conference
December 2-4, 1999, Renaissance Concourse Hotel Atlanta, Georgia
Please print out, complete and mail this registration form with payment to:
Black Family Ministry Project/ELCA
c/o Josselyn Bennett
8765 W. Higgins Road
Chicago, IL 60631
Personal Information
Your Name:
Organization:
Address:
City, State, Zip:
Phone number:
Registration Fees:
By November 29: $125.00
On-site registration: $150.00
Daily registration (for local residents): $50.00
Amount enclosed: ____
Form of payment: (Please check the appropriate blank)
Check ____
Make checks payable to: Black Family Ministry
Project/ELCA
Money Order ____
Credit Card____
Account No:
Exp. Date:
Hotel Information:
Renaissance Concourse Hotel
1 Hartsfield Center Parkway
Atlanta, GA 30354
404-209-9999
The room rate is $104.00 per night.
If requesting special room accommodations please check: ____
A hotel registration card will be sent to you upon receiving your completed registration card. Self parking available for $4.00 per day.