Deaf Chat Birthday!

Registration Form

The celebration will be held in Indiananapolis;
specific location TBA. Registrants will be responsible
for their own hotel reservations.

Yes! I’m excited about DeafChat's 10th Birthday Party,
and want to register.

Registration Form
* required

First Name*	Last Name*
Home Address*	Country*
City*	State*
Zip*	E-mail*

Registration package includes:

Program book, souvenir T-shirt, champagne flute, banquet ticket

Single: $125.00

Couple: $200.00

I understand that my credit-card registration order will appear
in my monthly-transaction statement as being charged to either
“MSM PRODUCTIONS, LTD.” or “DEAF LIFE PRESS.”

Pay by:
Account Number:
Account Name:
Account Exp:		/ (ex: 05/09)
		Please E-mail me confirmation after my registration has been entered. (All registrants will receive a receipt.)

Where did you hear about us? Any special instructions?

I have double-checked what I typed,
and I understand that my name, address, and personal data
will not shared with or sold to any outside company or group.

Please click only once, then wait.

Your order is secure!
Click here to see how our security system works
before sending us your order.

Cancellations and refunds

If you cancel your registration before January 31, 2008, you’ll receive a full refund. Cancellations made after this date will receive partial refunds (factoring in a processing fee of $15.00 and up), depending on how near to the party date they’re received. This is because as the date approaches, more time and money are invested in designing personalized items.

If you prefer to snail-mail the completed
reservation form, print it out and send to:

DeafChat Birthday Party
POB 23380
Rochester, NY 14692.
Or fax us at 585-442-6371.

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