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Conventions   >   Convention 2010   >   Online Registration

Registrant Information * indicates required field
Prefix
First Name*
Middle Initial
Last Name*
Suffix
Diocese / Community / Organization
Name on Badge	Up to 10 characters; first name if blank
Address 1*
Address 2
City*
State*	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Country (if outside US)
Zip / Postal Code*
Email
Telephone*
Fax	(Optional)
Special assistance, specific meal requirements*	Yes No
Describe:
First NOCERCC Convention?*	Yes No
Member Status*	Member Non-member Not sure Please check Member if you are: from a member diocese, religious community, organization; individual affiliate member.
Convention Fees
NOCERCC Members	Convention Registration, 1 Registrant: $600 Convention Registration, 2+ Registrants: $525 each
Other Participants	Convention Registration: Non-Member: $800 Convention Registration: Non-Member at Seminary/Theology School: $650 For lower member rates email nocercc@nocercc.org to inquire about membership.
Awards Banquet	Wednesday, February 10, 7:00 p.m. NOCERCC Members: $50 Other Participants: $60
Pre-Convention Opportunities
New Directors Workshop* ($400)	(Select One) Yes No   Feb 6, 7:00 p.m.- 7, 5:00 p.m.
Tours	Tour 1: Stanford University and Fogarty Winery ($55) Tour 2: Oakland Cathedral and Pier 39, San Francisco ($50) Please select no more than one tour option for Feb. 8
Payment and Submission
Payment Method*	Pay online with Paypal I am included with another participant's payment I will mail in a check after submitting the online form.
Confirmation & Cancellation: Check Yes to Accept Policy*	Yes No Registration confirmed only after payment received. If you need to cancel, you may request refund by email to aberger@nocercc.org or at postal address below, to be received in NOCERCC National Office by January 8, 2010; after convention we will refund your registration payment less non-refundable deposit of $150.
Number of registrations included in this payment, other than yourself*
Names of others included with this payment (if any)	Note that each registrant should submit his or her own form, even if they are included on this payment
Total Payment Amount	You may enter 0 if you are not paying wtih this registration
Security Code*	(Enter the code above)