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    ConferenceRegistration
  • Thank you for registering to attend the 2015 5p- Society Annual Conference. We want to make the process as easy as possible. This is a family registration form. Please note that a child is considered under 17 and will receive a child"s meal at the banquet. If you would like your "child" who is under 17 to receive an adult meal, please indicated under "meal selection." Your registration fee will increase by $25.00. We recognize that some adults with Cri du Chat Syndrome may need a soft meal and the children"s meal would be a better choice for them. If this is the case, please indicate under "meal selection."  Please fill out completely for each person who is attending. If you require additional space, please send an email to director@fivepminus.org. T-shirts may be ordered with your registration form. To guarantee your t-shirt order is received, please return this form no later than July 1, 2015. If you have any questions about this conference registration, please call 1-888-970-0777.
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  • Family Registration - (up to 2 adults & 2 children under 17)
  • Please indicate your membership type
  • Meal Selection
  • Meal Selection
  • Child Care (Child 1)
  • Sibling Outing (Child 1) (Sibling only)
  • Meal Selection
  • Child Care (Child 2)
  • Sibling Outing (Child 2)(Sibling only)
  • Meal Choice
  • On the next page you can register your additional adults and additional children
  • Additional Adult Registration - $50.00 each
  • Meal choice
  • Meal Choice
  • Meal Choice
  • Meal Choice
  • Additional Child Registration - $25.00 each
  • Child Care (Child 3)
  • Sibling Event (Child 3) (Sibling Only)
  • Meal Selection
  • Child Care (Child 4)
  • Sibling Event (Child 4) (Sibling Only)
  • Meal Selection
  • Child Care (Child 5)
  • Sibling Event (Child 5) (Sibling Only)
  • Meal Selection
  • Child Care (Child 6)
  • Sibling Event (Child 6) (Sibling Only)
  • Meal Selection
  • Address
  • Conference Information
  • Please include my Annual Membership renewal for $25.00
  • Please extend my Annual Membership renewal for 3 years at a discounted rate of $70.00
  • Do you need any of the following? Please note that you must reserve your crib and refrigerator with the hotel.
  • Photo Release: I/we acknowledge that I may be photographed, or recorded. I hereby release to the 5p- Society all proprietary rights and copyrights in all such photographs, digital images, voices, recordings, actions, films and likenesses (including negatives, positives and prints) which shall be and remain the property of the 5p- Society. l understand that this material may be used in various publications, public affairs releases, recruitment material, and broadcasts or for other related endeavors. This material may also appear on the 5p- Society"s website and other public social media sites. I expressly release the 5p- Society, its directors, officers, employees, agents, and volunteers, from any and all claims, including copyright and privacy, arising out of any reproduction, broadcast, distribution, publication, or promotion of this event
  • Please indicate by checking below what type of deletion your child with the syndrome was diagnosed with (if known).

  • Will you be staying at the Grand Hyatt San Antonio or a different location? Please indicate below

  • If you do not want to pay through PayPal, please stop here, print your form and send it into the 5p- Society office by mail with your payment by check or money order in US funds made payable to 5p- Society, PO Box 268, Lakewood, CA 90714. 
    If you want to pay with credit card through PayPal, please fill out the information below checking the correct boxes and adding in the correct quantities and then hit the "Proceed to Checkout" button.  Through PayPal you can pay by Visa, Mastercard, American Express, Discover, PayPal and echeck.  
    If you have any questions contact the 5p- Society at director@fivepminus.org

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