2018 Conference Registration Form

Bayou City Christian Writers Conference 2018

REGISTRATION FORM

Your Information

Name*

First NameLast Name

E-mail*

Confirmation Email

Updates

Yes, I want conference updates via email.

18+ years old?*

YesNo (Must be accompanied by a parent or legal guardian.)

Where are you traveling from? (optional)

Street Address

Street Address Line 2

Your town/cityState / Province

All minors must be accompanied by a parent or legal guardian. Provide adult's information below. He or she must sign the end of the form. There is an additional charge for the accompanying adult. No one younger than 13 years of age will be admitted. Thank you.

Parent/Guardian Information

Name

First NameLast Name

Home Number

Area CodePhone Number

Cell Number

Area CodePhone Number

E-mail

example@example.com

Emergency Information

Emergency Contact's Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Relationship*

Please let us know about dietary restrictions for menu planning purposes.

Please let us know if you have special needs.

Photo Release and Acknowledgement

I hereby grant ACFW, The Woodlands (a chapter of American Christian Fiction Writers) permission to use my likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration.

I understand and agree that all photos will become the property of ACFW, The Woodlands and will not be returned.

I hereby irrevocably authorize ACFW, The Woodlands to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.

I hereby hold harmless, release, and forever discharge ACFW, The Woodlands from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I HAVE READ AND UNDERSTAND THE ABOVE PHIOTO RELEASE.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Signature of Attendee (or Parent/Guardian of an attending minor). *

First NameLast Name

Register early, please.

Fees at the door are $80 for every person, no exceptions.

Choose one option below. Drivers and Companions must register separately so that we have emergency contact information, etc. Thank you for your help in this matter.

Registration*

Regular Registration$80.00

Minor ($40) + adult ($20)$60.00

Driver/Companion$20.00

Enter coupon

Total $0.00

Credit/Debit Card