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  • CM MN Registration Form

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    magoo65293
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    CM Minnesota - A Tale of Two Cities! e-mail completed registration form to. Please find me a roomie! # of Roommates requested: 1___________ 2___ _________________________________ (3 in room = $76. Ea / night; 3 in room = $51. Ea/night; 4 in room = $38 / night) food Information Snacks and bottled water will be available in the Hospitality Suite throughout CM MN.

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    CM Minnesota - A Tale of Two Cities! e-mail completed registration form to. Please find me a roomie! # of Roommates requested: 1___________ 2___ _________________________________ (3 in room = $76. Ea / night; 3 in room = $51. Ea/night; 4 in room = $38 / night) food Information Snacks and bottled water will be available in the Hospitality Suite throughout CM MN.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    198 views1 page

    CM MN Registration Form

    Uploaded by

    magoo65293
    CM Minnesota - A Tale of Two Cities! e-mail completed registration form to. Please find me a roomie! # of Roommates requested: 1___________ 2___ _________________________________ (3 in room = $76. Ea / night; 3 in room = $51. Ea/night; 4 in room = $38 / night) food Information Snacks and bottled water will be available in the Hospitality Suite throughout CM MN.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    of 1

    CM Minnesota - A Tale of Two Cities!

    Friday 8/29/14 - Monday 9/1/14

    Registration Form
    Please e-mail completed form to CMMinnesota@gmail.com
    Name:________________________________________________________________________________________
    Address:______________________________________________________________________________________
    City:_______________________________________________State:______________Zip:____________________
    E-mail (please PRINT clearly):__________________________________________________________________
    Please find me a Roomie! # of Roommates requested: 1___________ 2___________ 3___________
    (2 in room = $76.89 ea/night; 3 in room = $51.26 ea/night; 4 in room = $38.44 ea/night)

    Emergency and Medical Information


    (Medical info optional but strongly encouraged)
    Emergency contact Name:_____________________________________________Relationship:____________
    Phone:__(______)____________________Address:__________________________________________________
    Doctor's name:________________________________________________Phone:_(______)_________________
    Doctor's address:______________________________________________________________________________
    Medical insurance carrier:____________________________________________ID#______________________
    Blood type:________________________________________________________________
    ANY Medical Information you think I would need to know about in an
    emergency (allergies, bad knees, medications, etc.):

    Food Information
    Snacks & bottled water will be available in the Hospitality Suite throughout
    CM MN. Please let us know any special preferences or needs below:
    Likes

    Dislikes

    Special Diet

    Events Fee $270


    Payment Plan: 4 payments of $67.50 due 3/15/14, 4/15/14, 5/15/14, with full & final payment
    due 6/15/14.
    Preferable: Send $ electronically. most banks these days have ways to easily transfer $ or do
    e-checks for free. Citibank has "PopMoney", for example, where you only need a person's e-mail
    to send $. Use of PayPal is discouraged as they support Planned Parenthood.
    Also Fine: Checks by SnailMail to Margot Hird, P.O. Box 14236, Saint Paul, MN 55114.
    Email CMMinnesota@gmail.com for questions or call Margot @ (818) 648-7740.

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