REGISTRATION FOR
THE SUE MILLER
DAY OF CARING
Saturday, May 11, 2013

Conference fee: $50/individual
(each individual must register)

REGISTRATION DEADLINE: MAY 3, 2013

 

Registration Information:
First Name:  
Last Name:  
Address:  
City:  
State:  
Zip:  
email:  
Phone:  
()-
Dietary Restrictions:  
Dairy Free
Gluten Free
Vegetarian
Conference Fee:   Conference Fee of $50 per individual
      (Each individual must register separately)
   
Additional Donation:
   
I would like to make a donation to support others through
Day of Caring:  		 Friend: $100
Partner: $250
Patron: $500
Founder: $1000
Other Amount:
        		 
   
In memory/honor of: 
 
Please send a notice of this donation to:  
Name:  
Address:  
City:  
State:  
Zip:  
   
Survey Questions:
   
Are you a survivor? Yes
No

If yes, how many years?

What is your ethnicity (optional)? African American
Asian
Caucasian
Hispanic/Latina
Other, please indicate:
         
What language do you speak? English
Spanish
Other, please indicate:
         
How did you hear about the conference? Advertising
Email
Family/Friend
Mailed Invitation
Picked up registration brochure
        Where:
Radio/TV
Social media
 
   
   
For questions or more information (English & Spanish), email
info@dayofcaringcolorado.org or call 303-366-1681

PARKING AT THE HOTEL IS FREE.

Photography at event: There may be a photographer at the conference. Please note that as a registrant of this event, you hereby give Sue Miller Day of Caring permission to publish photographs or video taken during the conference.