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REGISTRATION FORM FOR ATLANTA HEARS CONFERENCE 99
hearing better @ Y2k.com
( not an email address)

      August 13-15, 1999                                                Unicoi State Park, Helen, Ga
This registration does not include the room reservations, which must be made separately with Unicoi or other facilities. Room deposit and reservation at Unicoi must be made before July 10th to insure a room will be held for you. Registration limited to 200 people.
Attendee    Name (as it will appear on badge): _________________________________
                    SHHH Chapter or Group Name:   _________________________________
                    Address:   ___________________________________________________
                    City:  _____________________________  State: ______  Zip:  _________
                    Daytime phone: __________________   Evening Phone:  _______________
                    Email address: _________________________         FAX:  _____________
Other Family Attendees
Name (as it will appear on badge):  __________________________________________
REGISTRATION RATES                             Before July 10                     After July 10
(Includes all Meals EXCEPT the Banquet)
Attendees (Number)   __________                  @$45.00 each                     @$65.00 each
Banquet per person     __________                 @$20.00 each                     @$20.00 each
             Total Amount Enclosed                      ___________                        __________
 
Signed:  ________________________________________  Date:  _________________
Mail this form and your check or money order made payable to ATLANTA HEARS, PO Box 501124; Atlanta, GA 31150. Registration limited to 200 people so register early and reserve your place.
All sessions will be captioned. ALDs and interpreters will be available.