The advance registration fee is $35.00, which covers all or part of the Young Feminist Summit and is non-refundable. You can print out this form, fill out one using secure transactions, or request one be sent to you by US mail.

PLEASE PRINT

__NOW Member __Non-Member

Name _____________________________________________________________

Address ___________________________________________________________

City ________________________________ St._______ ZIP__________________

Phone ( )________________________________ Age __________________ (optional)

Registration Fee (payable to NOW Foundation) $ 35.00

Charge: VISA OR MASTER CARD ONLY

__Visa __Master Card
Your Credit Card Number: ____________________________Exp. Date _________

Signature________________________________________________

Note: Please register in advance and inform us if you have special needs. The hotel is in compliance with the American Disabilities Act.

__Assistance Desired __Child Care Desired