CONTACT INFORMATION

School Name / Organizationrequired

Name of Registration Contact/Division Head required

This person will be contacted with questions about participants or registration information.

Registration Contact/Division Head Day Phone # required

(include area code)

Registration Contact/Division Head Email Addressrequired

How many participants are you registering?required

Complete the information below for the folks attending.

PARTICIPATION INFORMATION

PARTICIPANT #1

Namerequired

What name does the participant go by?required

(example William = Bill, Kathleen = Kathy

Participant "Weather/Travel Emergency" contact/cell number:required

(In case of last minute cancellations, lateness or travel advisories) Cell phone preferred

In what Division/Department does participant work?required

What is the participant's job title/subject taught?required

What is the participant's E-mail address?required

What pronoun does the participant use?required

(example: She/He/Them etc.)

Dietary Needs:*

Ominvore Eats Fish & Chicken Eats Fish Vegetarian Vegan Gluten Free Other Allergies, etc...

Food allergies, special requirements? required

Please explain.

While the kitchen is able to accommodate a wide variety of dietary needs, all foods are prepared in the same kitchen. We will provide delicious gluten-free fare for those who prefer not to eat gluten, but our kitchen is not gluten free. Those who have been diagnosed by a doctor with a life threatening food allergy, such as celiac disease, should consider supplementing our meals. Staff is available to discuss individual needs in advance of your arrival.

Does particpant have any physical restrictions, special accommodations needs or any other comments:*

Yes No

Please share any information here

Registration Optionsrequired

PARTICIPANT #2

Namerequired

What name does the participant go by? required

(example William = Bill, Kathleen = Kathy

Participant "Weather/Travel Emergency" contact/cell number:required

(In case of last minute cancellations, lateness or travel advisories) Cell phone preferred

In what Division/Department does participant work?required

What is the participant's job title/subject taught?required

What is the participant's E-mail address?required

What pronoun does the participant use?required

(example: She/He/Them etc.)

Dietary Needs:*

Ominvore Eats Fish & Chicken Eats Fish Vegetarian Vegan Gluten Free Other Allergies, etc...

Food allergies, special requirements? required

Please explain.

While the kitchen is able to accommodate a wide variety of dietary needs, all foods are prepared in the same kitchen. We will provide delicious gluten-free fare for those who prefer not to eat gluten, but our kitchen is not gluten free. Those who have been diagnosed by a doctor with a life threatening food allergy, such as celiac disease, should consider supplementing our meals. Staff is available to discuss individual needs in advance of your arrival.

Does particpant have any physical restrictions, special accommodations needs or any other comments:*

Yes No

Please share any information hererequired

Registration Optionsrequired

PARTICIPANT #3

Namerequired

What name does the participant go by?required

(example William = Bill, Kathleen = Kathy

Participant "Weather/Travel Emergency" contact/cell number:required

(In case of last minute cancellations, lateness or travel advisories) Cell phone preferred

In what Division/Department does participant work?required

What is the participant's job title/subject taught?required

What is the participant's E-mail address?required

What pronoun does the participant use?required

(example: She/He/Them etc.)

Dietary Needs:*

Ominvore Eats Fish & Chicken Eats Fish Vegetarian Vegan Gluten Free Other Allergies, etc...

Food allergies, special requirements? required

Please explain.

While the kitchen is able to accommodate a wide variety of dietary needs, all foods are prepared in the same kitchen. We will provide delicious gluten-free fare for those who prefer not to eat gluten, but our kitchen is not gluten free. Those who have been diagnosed by a doctor with a life threatening food allergy, such as celiac disease, should consider supplementing our meals. Staff is available to discuss individual needs in advance of your arrival.

Does particpant have any physical restrictions, special accommodations needs or any other comments:*

Yes No

Please share any information hererequired

Registration Optionsrequired

PARTICIPANT #4

Namerequired

What name does the participant go by?required

(example William = Bill, Kathleen = Kathy

Participant "Weather/Travel Emergency" contact/cell number:required

(In case of last minute cancellations, lateness or travel advisories) Cell phone preferred

In what Division/Department does participant work?required

What is the participant's job title/subject taught?required

What is the participant's E-mail address?required

What pronoun does the participant use?required

(example: She/He/Them etc.)

Dietary Needs:*

Ominvore Eats Fish & Chicken Eats Fish Vegetarian Vegan Gluten Free Other Allergies, etc...

Food allergies, special requirements? required

Please explain.

While the kitchen is able to accommodate a wide variety of dietary needs, all foods are prepared in the same kitchen. We will provide delicious gluten-free fare for those who prefer not to eat gluten, but our kitchen is not gluten free. Those who have been diagnosed by a doctor with a life threatening food allergy, such as celiac disease, should consider supplementing our meals. Staff is available to discuss individual needs in advance of your arrival.

Does particpant have any physical restrictions, special accommodations needs or any other comments:*

Yes No

Please share any information here

Registration Optionsrequired

PARTICIPANT #5

PARTICIPATION INFORMATION

Namerequired

What name does the participant go by?required

(example William = Bill, Kathleen = Kathy

Participant "Weather/Travel Emergency" contact/cell number:required

(In case of last minute cancellations, lateness or travel advisories) Cell phone preferred

In what Division/Department does participant work?required

What is the participant's job title/subject taught?required

What is the participant's E-mail address?required

What pronoun does the participant use?required

(example: She/He/Them etc.)

Dietary Needs:*

Ominvore Eats Fish & Chicken Eats Fish Vegetarian Vegan Gluten Free Other Allergies, etc...

Food allergies, special requirements? required

Please explain.

While the kitchen is able to accommodate a wide variety of dietary needs, all foods are prepared in the same kitchen. We will provide delicious gluten-free fare for those who prefer not to eat gluten, but our kitchen is not gluten free. Those who have been diagnosed by a doctor with a life threatening food allergy, such as celiac disease, should consider supplementing our meals. Staff is available to discuss individual needs in advance of your arrival.

Does particpant have any physical restrictions, special accommodations needs or any other comments:*

Yes No

Please share any information here

Registration Optionsrequired

FEES & PAYMENT

Total registration fees for this registration. Answer the questions below and then hit submit.

How would you like to pay?

Credit Card Mail in Check

To whom should the invoice be sent?

Payment Contact Namerequired

Payment Contact Emailrequired