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DignityUSA 2007 National Convention Registration Form

July 5^th through the 8^th 2007
Hyatt Regency Town Lake,
Austin, TX

Registrant #1

Registrant#2
(for couples/families residing at same address)

Name:*

First:

Last:

First:

Last:

Name on Badge:

Street Address 1:*

same

Street Address 2:

same

City:*

same

State:*

same

Zip/Postal Code:*

same

Country:*

same

Primary E-mail Address (for Convention updates):*

same

Home Phone:

same

Chapter Affiliation
(if any)

same

Member/Organization

DignityUSA

Dignity/Canada/Dignité

Other(please specify)

Childcare:

I plan to bring my child(ren) to the Convention.

Including this one, how many conventions have you attended? Registrant #1 Registrant #2

Special Needs:

Please describe any ADA requirements or special needs you may have, including mobility restrictions, sign language, dietary restrictions or child care (list names and ages of children)

Participation Opportunities:
(Please respond by May 31st)

I would like to volunteer at Convention 2007 for the following: (Registrant 1, please use first checkbox)
Choir Member	Lector
Liturgical Dancer	Musician (Instrument)
Sign Language Interpreter	Language Interpreter (please specify language)
Eucharistic Minister	Language Interpreter (please specify language)
Registration	Other(please specify)


Leadership Conference
YES, I will attend the Leadership Conference on Thursday, July 5th, from 8:00 AM to 3:00 PM.


Hotel Reservations
DignityUSA has negotiated a special room rate for the convention at the Hyatt Regency Austin. Room rates are $120 per night (plus state and local taxes), and you may have up to four people in a room at this rate. To get the convention room rate, make reservations directly by phone, by calling 800-233-1234 or 512-477-1234. Just mention our group name “DignityUSA 2007 Convention” to receive the discounted room rate. Please make your reservations early, as the cut-off date for reserving the convention rate is June 11, 2007. Reservation requests after the cut-off date will be based on availability at the hotel’s prevailing room rates. You may check the hotel’s web site at http://austin.hyatt.com/hyatt/hotels/index.jsp, but you will not receive the convention discount via the Web.

Amtrak and Travel Reservations

Taxis from ABIA (Austin Bergstrom International Airport) to the Hyatt Regency hotel are currently about $20 each way. Although our hotel does not provide shuttle service to or from the airport, Super Shuttle (currently $12.50 each way from ABIA) provides transport to the Hyatt Regency. Austin municipal buses (50 cents each way) also go from the airport to downtown locations near our hotel, so check at the airport information desk about bus routes if you do not have much luggage and would like to take a city bus. Although AMTRAK service to Austin is rather limited, the AMTRAK station is only about one-mile from our hotel. If you drive to Austin or have a rental car, parking at the Hyatt is free for Hyatt hotel guests. For those staying elsewhere, parking at the Hyatt Regency currently is $9 per day.

Section A: Full Conference Attendance at the full DignityUSA Convention includes: all ceremonies, caucuses, liturgies, plenary sessions, workshops, Saturday dinner dance and Sunday brunch. All rates are per person.
		Num. of Persons	Total Charges
Early Registration – To qualify for early registration, you must have already paid a $100 down payment	DignityUSA Member Rate: $200 - $100 = $100		$ .00

Regular Registration – Registrations must be received by May 31, 2007	DignityUSA Member Rate: $240*		$ .00
*Member rate includes members or organizational members of DignityUSA	Non-member Rate: $295 (See below to become a member)		$ .00

Late Registration – Registrations received after May 31, 2007	DignityUSA Member Rate: $275*		$ .00
*Member rate includes members or organizational members of DignityUSA	Non-member Rate: $325 (See below to become a member)		$ .00

Young Adult Registration – 25 years or under.	Young Adult Rate: $125		$ .00
Subtotal Section A:			$ .00
DignityUSA Membership is free! Please join and add your voice to the only Catholic organization for GLBT people of faith, our family and friends. You may join, renew or upate at www.dignityusa.org YES, I want to become a member of DignityUSA! You may opt out of voting membership (what this means…). I/we wish to opt out of voting membership and be a donor/friend only. I/we also wish to opt out of receiving any DignityUSA mailings. From time to time, DignityUSA shares our mailing list with collaborating organizations. Check here if you do not wish your name to be shared.

Scholarship Assistance

I would like to be considered for scholarship assistance.

Limited Income – Resources may be available to those who need financial assistance to attend the convention. Requests must be postmarked no later than May 31, 2007. You will be contacted regarding your request. Please complete the personal information above and submit with your request to the convention address.

Sister Eileen DeLong Scholarship Fund – Scholarships from this fund are available to women religious and possibly men religious and others depending upon availability, who wish to attend Convention 2007. For a copy of fund guidelines and for an application, please write: Sister Eileen DeLong Scholarship Fund Committee, DignityUSA, P. O. Box 15373, Washington, DC 20003-0373 or call 800-877-8797. Applications must be postmarked by May 31, 2007.

Young Adult Registration Scholarships are available. Please contact DignityUSA at the above address/phone for more details.

Section B: Single-Day Events (Full-coverage registrants may omit this section)
		Num. of Persons	Total Charges
Friday Attendance – July 6, 2007	By May 31, 2007: $100		$ .00
	After May 31, 2007: $125		$ .00

Saturday Attendance – July 7, 2007 (Dinner NOT Included)	By May 31, 2007: $100		$ .00
	After May 31, 2007: $125		$ .00

Saturday Dinner Dance – July 7, 2007	Member/Non-member Rate: $75 (See below to become a member)		$ .00
Subtotal Section B:			$ .00

Section C: Sponsorship Opportunities (Suggested donations in parentheses)
Keynote Speakers ($2500)	$ .00	Music for Choir ($200)	$ .00
Workshop Sessions($1000)	$ .00	Liturgies ($100)	$ .00
Opening Ceremonies/Reception ($500)	$ .00	Flowers for Chapel ($50)	$ .00
Parade of Banners ($400)	$ .00	Flowers for Liturgies ($50)	$ .00
Chapel ($400)	$ .00	Dinner Dance Decorations ($25/table)	$ .00
Subtotal Section C:			$ .00

DignityUSA gratefully acknowledges financial contributions in our publications.

Please note here how you would like your name(s) to be listed:
or Please check here if you wish to remain anonymous.

Section D: Display Ads for Program
	Fee	Quantity	Total Charges
Full Page (8" x 10")	$300		$ .00
Half Page (8" x 5" or 5" x 8")	$200		$ .00
Quarter Page (4" x 5" or 5" x 4")	$100		$ .00
Eighth Page (2 1/2" x 4" or 4" x 2 1/2")	$75		$ .00
Program Name and Greeting Listing (no more than 50 characters, including spaces)	$25		$ .00
Subtotal Section D:			$ .00
Submit camera-ready artwork no later than May 31, 2007 to DignityUSA Convention 2007, P. O. Box 15373, Washington, DC 20003-0373 or via email to conv07@dignityusa.org

Section E: Convention 2007 Polo Shirts, T-Shirts and Hats Orders received by May 31st ensure that your shirt(s) or hat(s) will be available at the convention registration table.
	Indicate Shirt Size and Quantity Ordered for Each Size						Total number of shirts/hats ordered	Total cost
	Child	S	M	L	XL	XXL	Total number of shirts/hats ordered	Total cost
Polo Shirt — $30 each								$ .00
T-Shirt — $20 each								$ .00
Hat — $20 each		(One adult size fits all.)						$ .00
Subtotal Section E:								$ .00

Section F: Workshop Interest Please indicate the top five workshops that you may be interested in attending. Please see workshop list for details.
Finding Queer Saints	A Conversation with Bishop John Shelby Spong	The Gospel of Thomas & Wisdom Spirituality
Queer Rites, Prophetic Sacraments	Experiencing Peace that Passes All Understanding	Hymn of the Cosmos
Praying Psalms with Body Prayer	John McNeill, Our Friend	DignityUSA Chapter Development
Re-Birth: The Spiritual Journey of a Catholic Lesbian	Hope in a Time of Transition	Our Prophetic Voices
Sex and the Sacred: Gay Identity & Spiritual Growth	John Paul I	Men’s Health
A 60 Minute Epiphany in July	Changing Hierarchical Structures	Defender’s Voice & Leather Spirituality
From Nothingness & Beyond Chaos	Children’s Workshop	Experiencing Leather Life as Spiritual Growth
Please note that not all workshops have been announced. These workshops are working titles and are subject to change.

Financial Assistance & Donations
Financial Assistance – I would like to make a contribution to help others attend Convention 2007	$ .00
DignityUSA Donations – I would like to make an additional donation to DignityUSA to support its work and mission to GLBT Catholics	$ .00

Section Totals
A. Full Conference	$ .00
B. Single-Day Events	$ .00
C. Sponsor Opportunities	$ .00
D. Display Ads for Program	$ .00
E. Convention 2007 Polo Shirts, T-Shirts and Hats	$ .00
Financial Assistance	$ .00
DignityUSA Donations	$ .00
Grand Total	$ .00

Method of payment
	Check enclosed payable to DignityUSA (Please print and mail this form to DignityUSA Convention 2007, P. O. Box 15373, Washington, DC 20003-0373.)
	Credit Card

Thank you. Please click "Submit" to proceed.

If you have difficulty submitting this form, you may email your information to info@dignityusa.org or print this form and fax to 202-543-5511.

DignityUSA is a 501(c)(3) nonprofit corporation. Gifts are tax deductible to the full extent allowed by law.

RETURN TO > CONVENTION 2007 >HOME

Join us in Austin!

DignityUSA 2007 National Convention Registration Form

Personal Information

* Required fields are indicated by an asterisk.

Leadership Conference

Hotel Reservations

Amtrak and Travel Reservations

Section A: Full Conference

Subtotal Section A:

Scholarship Assistance

Section B: Single-Day Events (Full-coverage registrants may omit this section)

Subtotal Section B:

Section C: Sponsorship Opportunities (Suggested donations in parentheses)

Subtotal Section C:

Section D: Display Ads for Program

Subtotal Section D:

Section E: Convention 2007 Polo Shirts, T-Shirts and Hats

Subtotal Section E:

Section F: Workshop Interest

Financial Assistance & Donations

Section Totals

Method of payment

Thank you. Please click "Submit" to proceed.