Conference Registration Form

I will be attending:

The Lifegiver's Festival on _________________________________________________

Shared Connections on ____________________________________________________

Name:__________________________________________________________________________

Name/age of child(ren): _______________________________________________________

Address: ________________________________________________________________________

City: ___________________________________ State: _________Zip Code:_________________

Work #: _______________________________ Home #: _________________________________

E-mail Address: ___________________________________________

Web Address (if any): ______________________________________

Special Diet? Other Needs?: _________________________________

Check here if you would like your personal information omitted from the conference materials.

I will require transportation to Detroit Metropolitan Airport.

Sponsored by (if applicable): _________________________

Visa and MasterCard accepted.

Card #_________________________________________ Experation Date:_________________

Cardholder's Signature:___________________________________________________________

Checks and money orders should be made out to Insight.

Please send your registration to: Brenda Romanchik, Insight, Open Adoption Resources and Support, 721 Hawthorn, Royal Oak, MI 48067

phone - 248-543-0997