First Annual Ventura County Women's Forum:
ECONOMIC JUSTICE
Saturday
October 14, 2006
8 am to 3:30 pm
Grand Vista Hotel (map)
999 Enchanted Way
Simi Valley, CA
Click to Register Online
Click for Printable Registration Form
Deadline for your org. to be included in the booklet of services: Sep 14, 2006
Deadline to receive confirmation packet by mail: Sep 30, 2006
Registration limited to the first 125 paid registrants
 
ONLINE REGISTRATION
 

Registration will be limited to the first 125 paid registrants. Applications will be processed in the order they are received and paid in full. If capacity has been reached prior to processing your application, you will be contacted within a week and your registration fee will be returned.

Complete your registration prior to Sep 30, 2006 to receive your Registration Confirmation Packet by mail. The Registration Confirmation Packet will include your receipt, ticket/badge, a copy of the book, McDonaldization: The Reader by George Ritzer (2006), courtesy of SAGE Publications, and a list of other recommended reading material.

Name

Organization

Title/Position

Address

City/State/Zip

E-mail

Home Phone

Additional Registrants:

Special Needs:
Vegetarian Meal
ADA Accommodations (please specify)

If you represent a service organization, please submit the following information prior to September 14, 2006 to be included in a booklet of services that will be distributed at the Forum:

Name of Organization

Phone

Email

Website

Brief Mission Statement (75 words or less)

Check which services your organization provides:

Campaign Assistance

Hospice

Scholarships

Childcare Assistance

Housing Assistance

Scholarship Counseling

Counseling

Immigration Assistance

Senior Services

Domestic Violence/Abuse

Job Placement

Tax Assistance

Family Services

Job Training

Teen Services

Financial Assistance

Labor Representation

Transportation Assistance

Financial Planning

Leadership Training

Tutoring

Grants for Individuals

Legal Assistance

Volunteering

Grants for Organizations

Legislative Assistance

Other:

Health Care

Mentoring

 

Health Education

Parent Education

 

Does your organization offer scholarships or grants?        Yes      No

If yes, please fill in the following information:

Eligibility Requirements


Contact Name


Phone


Registration Fee: $60 per person. Check your method of payment:

I will mail a check separately to VCCF/VCCW Forum Fund, Tax ID #77-0165029, VCCW, 4245 Market Street, Ste. 201, Ventura, CA 93003.
Amount

I will submit an on-line payment using a link to paypal on the next page. (You do not need to have or open an account with paypal to pay with a credit card.)
Amount