CODE Registration Form 2012 by P97o75wv

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									                                                             CODE 2012
                                            "Charting a Course for Still Waters"
                                           2012 CONFERENCE REGISTRATION
                                                                   www.codelink.org

                                        Sheraton Annapolis Hotel in Annapolis, Maryland
                                                     April 17 – 20, 2012
                                   Note: Hotel reservations must be made separately.
             To receive our conference rate of $99 per night, reservations must be made by March 15, 2012.
 Contact the Hotel at 1-410-266-3131, 1-888-627-8980 and reference CODE 2012 - Conference of Diocesan Executives
           or online at http://www.starwoodmeeting.com/StarGroupsWeb/res?id=1112277252&key=8F676

Last Name: ____________________________________                            First Name: ______________________________________

Name You Prefer: _______________________________                           Title: ____________________________________________

Guest’s Name: _________________________________                            Diocese: _________________________________________

Diocesan Position: _________________________________________________________________________________

Address:      ________________________________________________________________________________________

              ________________________________________________________________________________________


Office Phone: ____________________                     Cell: _____________________      Email: ______________________________

PLEASE CHECK CATEGORIES FOR WHICH PAYMENT IS BEING MADE:

___    Conference Registration for CODE Members:
       (Includes registration fee and all conference workshops and meals. Does not include lodging.)
       EARLY BIRD REGISTRATION FEE before 2/15/2012 - $400.00                                    $425.00 US         $_________
___    Registration for Guest of CODE Member:
       (Includes all conference workshops and meals. Does not include lodging.)                  $275.00 US         $_________
___    CODE Membership Dues:                              First Member:                             $100.00 US      $_________
       (If not paid already)                              (Additional Member: $75.00 / Retired: $50.00)
                                                                                                 TOTAL ENCLOSED     $_________

I will be coming from the ECBF Conference and will need a ride from the Maritime Center ____

PLEASE INDICATE CONFERENCE MEALS INCLUDED IN REGISTRATION FEE THAT YOU PLAN TO ATTEND:
(If you are bringing a guest, please include them in this count)
___Tuesday Opening Dinner                          ___ Wednesday Dinner at the Maryland Inn       ___Friday Breakfast
___Wednesday Breakfast                             ___Thursday Breakfast                          ___Friday Lunch/Meeting
___Wednesday Lunch                                 ___Thursday Lunch                              ___Friday Dinner/Banquet

PLEASE CHECK EACH CATEGORY THAT APPLIES TO YOU:

___ This is my first CODE Conference
___ I am a “new” Diocesan Executive
___ I am unable to attend the CODE Conference this year, but wish to continue my membership (dues enclosed)

___ Special Dietary needs: __________________________________________________________________________

___ Special Mobility needs: __________________________________________________________________________

                    Mail registration form and check (made payable to Conference of Diocesan Executives) to:
                                David Robinson, Director of Finance, Diocese of Southern Ohio
                                           412 Sycamore Street, Cincinnati, OH 45202

								
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