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Your Information

Email:

First Name:

Last Name:

Organization Name:

Organization Address:

Organization Zip Code:

Phone Number (work):

Phone Number (cel/home):

Lodging

I need a room for Tuesday night (5/29):
    Yes
    No

I need a room for Wednesday night (5/30):
    Yes
    No

I am attending the Sistersong Conference:
    Yes
    No
    Unsure

I want to room with (specify name, if any):

Roommate gender preference for room sharing (if none, leave blank):

I need my own room (if so, please explain):

I prefer to have my own room and can pay the difference ($55 per night)
    Yes
    No

Other Information

Dietary needs (vegetarian? kosher? please indicate):

Need accomodations due to a disability? (please let us know before April 1st)

Do you need Childcare? (please let us know before April 1st)
    Yes
    No

Funding

Can your organization provide you with airfare?
    Yes
    No

Can your organization provide you with hotel costs? A shared room costs $55 per night. A single room costs $109 per night.
    Yes - Single
    Yes - Shared
    No

We are committed to ensuring that all organizations who wish to attend are able to do so. We have funding available for those whose organizations are unable to pay for transportation and/or lodging, limited to one person per organization. More are welcome if your organization's funding permits.

Any additional comments: