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La Leche League of Eastern Pennsylvania
2016 Area Conference

Registration Form

PRIMARY REGISTRANT:
Name:
Address:
City: State: Zip:
Phone:
Email:
LLL Group you attend:

Check all that apply:
Leader ( yrs)
Leader Applicant
LLL Member		  
IBCLC
RN		  
Conference Speaker   Alumna Leader
Area Council (specify)
Other (specify)
Seat me at the Alumnae table
 
I am attending for CERPs (Please include $12 fee per CERP session)
 
Yes! I am interested in volunteering (check all that apply)
Where:
 Children's Activities   Registration   Area Sales
Silent Auction   Where Needed
When:
Registration   Ses 1   Ses 2   Ses 3   Ses 4 Close   as needed

Check here if you have a disability and may require accommodation to fully participate. Please indicate need:

Stroller permit for special situations such as multiples or mother/baby with disabilities.

 

Please list all people who will accompany you to the conference:

Name Relationship to Registrant
 

 
PRIMARY REGISTRANT WORKSHOP SELECTIONS
Saturday:
Session 1
Session 2
Session 3
Session 4
Sunday:
Session 5 - Plenary Session - What's New? Recent Breastfeeding Research
Session 6
Session 7

 

Secondary Registrant Information:
Name:
Check all that apply: Spouse/Partner   Grandparent  
Speaker   Other (specify)

We would be happy to print a listing of your session topic numbers and rooms so that a caregiver not planning to attend sessions can locate you should the need arise.
Caregiver needs a list of session locations only
Caregiver will attend sessions with mother and baby

SECONDARY REGISTRANT WORKSHOP SELECTIONS
Saturday:
Session 1
Session 2
Session 3
Session 4

 
REGISTRATION $ each Qty $ Subtotals
Friday
Primary Registrant Free 0.00  
Family Members Attending Free 0.00  
Conference Opening ONLY (free w/registration) $5.00
Saturday
LLL Leader/Applicant/Alumna $80.00  -----
LLL Member $90.00  -----
Non-Member $100.00  -----
Spouse/Grandparent   Free 0.00  
Alumnae Special (lunch/session 304 only) $32.00  -----
Sunday: Leader Enrichment Workshop
Leader/Applicant/Alumna $45.00  -----
OTHER FEES
Late Fee (October 11-15) $10.00  -----
On-Site Late Fee (after October 15) $15.00  -----
LLL EPA Basic Annual Membership $30.00
LLL EPA Annual Membership $50.00
CERP Fees (per session) $12.00
MEALS
Saturday Luncheon Buffet (1 included with primary registration)
Primary Registrant (* Must mark 1 here or kosher if eating lunch)   Free 0.00  
Adult (additional, age 12 and up) $27.00
Child (age 3-11 yr) $14.00
Child (under age 3)   Free 0.00  
Kosher Meal, meat, Primary Registrant   Free 0.00  
Kosher Meal, meat (all ages) $27.00
Saturday Dinner Buffet (not included with registration)
Adult (age 12 and up) $27.00
Child (age 3-11 yr) $14.00
Child (under age 3)   Free 0.00  
Kosher Meal, meat (all ages) $27.00
Sunday Plated Lunch (1 included with primary registration)
Primary Registrant (* Must mark 1 here or kosher and note
food choices below if eating lunch)		   Free 0.00  
Adult (age 12 and up) (* Mark choices below) $36.00
Child (age 3-11 yr) (* Mark choices below) $18.00
Child (under age 3)   Free 0.00  
*Please mark choices
Meal choices (#): Chicken: Pork: Vegetarian:
Dessert choices (#): Fruit plate: Chocolate cake:
Kosher Meal, meat, Primary Registrant   Free 0.00  
Kosher Meal, meat (additional, all ages) $36.00
CONTRIBUTIONS
Donations (see below)  -----  -----
Friendly Messages (see below)   $5.00
Children of LLL (see below)   $2.00
Total charges:
Discount:  _
Discount coupon code(s):    
DO NOT LEAVE THIS SPACE BLANK ----> TOTAL DUE:

Please check your math carefully! You must enter your total amount due in the space marked "TOTAL DUE", or your PayPal payment will not work!!

Donations
Name as you wish it to appear in the program booklet Donation
Total donation:   
Friendly Messages
Message 1:
Message 2:
Total Friendly Message donation ($5 each):   
Children of LLL
Total Children of LLL donation ($2 per name):
Note: Children of LLL and Friendly Messages must be received by October 10, 2016 to ensure inclusion in the Program Booklet.

Comments or questions for the registrar:

You must enter your total amount due in the space marked "TOTAL DUE" above, or your PayPal payment will not work!

You do not need a PayPal account to use PayPal to send a credit card payment.

Registrations received after October 15 will be processed as walk-ins. Please see the Registration Information page for details.

Please report any problems with the online registration process to beanmom@beanmom.com.

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