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2004
Conference Registration Form
Register by January 1, 2004 and save $130 off full conference
fee!
Please print and fax this form to: (414) 778-1552 and to
guarantee your spot also mail to: STOPDV, Inc., Attn: K. Young,
1550 N. 49th St., Ste. A, Milwaukee, WI 53208. For more
registration info, call (414) 778-1134 and for more
conference information call (858) 679-2913.
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Personal Information
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Name (Please Print or Type Legibly):
_________________________________________________
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Position
/ Field (Please check only one):
___Victim advocate
___Victim witness
___Forensic nurse
___Physician
___Other medical
___Law enforcement
___Prosecutor
___Criminalist
___University/Campus Program
___Military
___Researcher
___Educator
___Mental Health
___Other (please specify)____________________________
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Organization:______________________________________
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Address:
_________________________________________ |
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City:
______________State: ________ZIP:______________
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Day
Phone ( )____________Fax:
( )_______________
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Email:____________________________________________
For a confirmation letter, you must
supply an email address or a fax number. Please write clearly! |
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Special
Needs (Wheelchair accessibility, Child Care, Other - please be
specific): _________________________________________________
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Areas
of Interest (check all that apply):
___Sexual assault
___Domestic violence
___Stalking
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Fees
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Register early and save! Only
registrations sent with payments before the cutoff date qualify for
special rates. You may use a P.O. to register, however
actual payment must be received by the appropriate cut off date
to qualify for the early rate. Submit your paperwork early so
that you can take advantage of this offer. If your agency will
not pay until after you have attended the conference, you will not
qualify for the early rate.
No exceptions can be made. No refunds will be given after
March 7, 2004.
For groups of 5 of more, the 5th registration
is FREE.
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$399.00 if registration is received by January 15, 2004 |
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$469.00 if
registration is received by February 15, 2004 |
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___ $529.00 if
registration is received after February 15, 2004 |
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$250.00 Student Rate - Must present valid student ID at
check-in! |
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$250.00 Partial Scholarship |
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I cannot attend, but would like to order the 2004 Conference Manual
and Resource CD for $100 |
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Fees Include:
- 3 days of training with
fantastic speakers and trainers
- 3 continental breakfasts & coffee breaks
- 3 seated lunches
- Full set of course
materials
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Method of Payment |
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Check - Make check payable to STOPDV, Inc.
(EIN:91-19869095) |
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Money Order ___ Purchase
Order #: __________________
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Credit Card: ___
Visa
___MasterCard
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Credit Card Number: ____________________________
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Exp. Date: ____________________________________
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Security/Customer
Code:_________________________
(3 or 4 digit non-embossed # on the back or front of card)
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Cardholder Name: ______________________________
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Cardholder Billing Address/ZIP: ___________________
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______________________________________________
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Cardholder Signature:
____________________________________
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Hotel Reservations
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Make your reservations directly with the Holiday Inn at
1-800-877-8920 or 619-232-3861. When making reservations, make
sure to ask for the International Domestic Violence, Sexual Assault
& Stalking Conference special group rate of
$149.00 (single or double). These special rates will be in
effect 2 days after the conference. The first 425 reservations
will qualify for this rate.
The Holiday Inn on the Bay provides free shuttle service to a
number of local attractions. The San Diego Metro Trolley service
is close by.
For overnight hotel guests, the rate for
parking at the hotel is $15.00 per day and for daytime visitors,
it is $5.00 per day.
The address of the Holiday Inn is 1355 N. Harbor. Harbor runs
parallel to Pacific Highway, so 1500 Pacific Highway would be two
blocks from the conference Hotel.
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Additional Hotels in Downtown San Diego:
-
Pacific Inn Hotel & Suites, 1615 Pacific Highway
(619) 232-6391
- Villager Inn, Gaslamp
District, 660 “G” Street (866) 833-9330
- Harbor View Days Inn,
1919 Pacific Highway, four blocks from the conference hotel
(619) 232-1077
- Quality Inn Suites Harborview, 1430 7th Avenue
(619) 696-0911
- Rodeway Inn, 833 Ash
Street, (619) 239-2285, exactly one mile from
the conference hotel
- Comfort Inn at the Harbor,
5102 N. Harbor Drive, (619) 223-8171 (Not
within walking distance)
- Hampton Inn, 1531
Pacific Highway, (619) 291-8333
- Best Western Bayside,
619-233-7500
- Hilton Gaslamp Quarter,
SD Downtown, 619-231-4040
You can search on
google.com
for more hotels in the downtown area. A good choice is
expedia.com. |
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