DIC5 Registration Form

DIC5 Registration Form
Personal Information
1. Name*

First NameLast Name
2. Preferred Name (for badge):*
3. Affiliation/Organization (optional):
4b. What is your gender?*

FemaleMaleNon-BinaryOther
4a. Pronoun

He/HimShe/HerThey/ThemOther
5. Email*
example@example.com
6. Mobile/Text*
Please enter a valid phone number.
7. VideoPhone
Please enter a valid phone number.
8. Emergency Contact Person*
9. Relationship*
10. Contact Number*
Please enter a valid phone number.
11. Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
12. How did you learn about Deaf Interpreter Conference 5?*

Social Media (Facebook, Instragram, LinkedIn)WebsiteE-blast newsletterFamily or FriendColleague
13. Which of the following best describes you? (Check all that apply)*

InterpreterTranslatorEducator/TrainerLinguistStudentAgencyBusiness/VendorSponsorOther
14. Which DIC conference have you attended?*

DIC 1 in St. Paul, MN, 2015DIC 2 in Villanova, PA, 2017DIC 3 in Monmouth, OR, 2019DIC 4: Virtual, 2022I have not been to any DIC, this will be my first!
Registration Options
15. Please select your registration option below:*

Full Conference: June 22 - 26, 2026Day Pass: June 22, 2026 (Day 1)Day Pass: June 23, 2026 (Day 2)Day Pass: June 24, 2026 (Day 3)Day Pass: June 25, 2026 (Day 4)Day Pass: June 26, 2026 (Day 5)
Lodging Options

We encourage everyone to stay on campus, but we understand that some attendees have personal preferences. We like to provide options for everyone.
16. Please select your lodging preference for DIC5:*

CSDR Cottage (available only for FULL conference attendees, limited capacity). Please click Cottage add-on in Zeffy upon checkout.Hotel (Hyatt Downtown Riverside) Click the booking link below.No lodging needed (I will take care of my own arrangements)
Booking link for the Hyatt Downtown Riverside
17a. Roommate Preference (only if selecting CSDR cottages)

I would like to choose my own roommate (please provide name(s) below left):I am happy to be assigned a roommate (please choose an option below right):
17b.Roommate Name(s)
17c. Roommate Assignment Considerations

I am comfortable with any roommateI would prefer a roommate of the SAME gender I identify withI would prefer a roommate of a DIFFERENT gender I identify withOther
17d. Special Lodging Needs: Accessibility requirements, allergies, other requests or considerations:
DIC5 Conference Policy Agreement
To ensure a positive experience for everyone, we ask all attendees to uphold the values reflected in the RID Code of Professional Conduct: respect, integrity, and inclusion. By registering for and attending the Deaf Interpreter Conference 5 (DIC5), participants agree to the following policies and standards:

1. Foster an Inclusive Environment

DIC5 values linguistic and cultural diversity, accessibility, and equity. Please be mindful of access needs, respect interpreters and support staff, and help maintain a space where everyone feels seen and included. Participants agree to honor communication access and contribute to an environment that supports all attendees.

2. Demonstrate Professional Conduct and Courtesy

We represent our communities and professions through our behavior. Let’s model the courtesy, integrity, and collaboration that define ethical and effective practice. All attendees are expected to engage in respectful, professional, and inclusive behavior at all times.
- Harassment, discrimination, or any disruptive or disrespectful conduct will not be tolerated.
  - This includes bullying, intimidation, exclusion, or verbal abuse—any actions that compromise courtesy, safety, or mutual respect.
- Political, religious, or offensive statements or materials that may cause discomfort or division are not permitted.
- All participants are expected to maintain a safe and respectful environment during conference sessions and in lodging spaces.
3. Lodging Conduct (CSDR Cottages)
- Participants staying in “and visiting” the CSDR cottages are expected to follow all dormitory rules and respect shared living spaces.
- Quiet hours must be observed.
- No drugs, alcohol, or disruptive gatherings are permitted on the CSDR campus.
- Inappropriate or sexual behavior in shared spaces is prohibited.
- Treat all roommates and property with respect.
- Violations may result in immediate removal from campus housing at the attendee’s expense, with no refund for lodging or registration.
4. Photography, Video, and Recording Consent

Recording or photographing sessions without prior consent is strictly prohibited.
By attending DIC5, you acknowledge and consent that official DIC5 photographers and videographers may capture photos and video footage during conference events.
These materials may be used for documentation, promotion, or educational purposes by the DIC5 Planning Committee.If you prefer not to appear in media materials, please inform the registration desk upon check-in so accommodations can be made.

5. Compliance with Venue Policies

Attendees must comply with all CSDR campus policies, local laws, and any directions from conference staff or volunteers.

6. Consequences for Policy Violations

Any participant who violates these policies or engages in unsafe, inappropriate, or disrespectful behavior may be asked to leave the conference at their own expense. No refund will be issued.

By participating in this event, we help create a space where learning, respect, and connection thrive. Thank you for contributing to an environment that reflects the best of our professional and Deaf communities. If you have questions or concerns about this policy, please reach out to the DIC Co-Chairs during the conference.
Acknowledgment. By completing registration, I acknowledge that I have read, understand, and agree to abide by all DIC5 conference policies and the Code of Conduct.

Entering your name below serves as your electronic signature.
18a. Print Full Name*
18b. *

MonthDayYear
Date
19. Please select your T-shirt size

XSSMLXLXXL
Payment
20. How will you pay for your DIC5 Conference registration?

I will pay the full registration priceI will arrange an installment plan (To secure your spot, pay the first installment.)I will apply for scholarship (To secure your spot, a deposit of $100 is required.)
Payment is processed through Zeffy. After you click CONTINUE below, this form will be SUBMITTED and you will be redirected to the Zeffy Online Payment Registration Form. Once payment 💵 is RECEIVED, your registration is CONFIRMED. ✅
Should be Empty:

DIC5 Registration Form

Personal Information

Registration Options

Lodging Options

DIC5 Conference Policy Agreement

Acknowledgment. By completing registration, I acknowledge that I have read, understand, and agree to abide by all DIC5 conference policies and the Code of Conduct.

Payment