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Online Registration
(Credit Card / PayPal)
Click here to download a printable
Scholarship Form (.pdf)
Scholarship Form (.doc)
| Registrant Information |
|
Name:______________________________________________ |
Nickname / Preferred Name: _____________________________ |
| Name as you'd like it to appear on your badge: _____________ |
|
| Address:____________________________________________ |
City__________________ State_______ Zip_________________ |
Phone: h.( _ _ _ ) - _ _ _ - _ _ _ _ / c. ( _ _ _ ) - _ _ _ - _ _ _ _ |
Email: _______________________________________________ |
| Special Needs and/or Contact Instructions (e.g. difficulty climbing stairs, what name to ask for when calling, best time of day to call, etc.) Please write/type below. Continue on the back or attach additional sheets if necessary. |
___________________________________________________________________________________ ___________________________________________________________________________________ |
| I identify as … Continue on the back or attach additional sheets if necessary. Feel free to be creative! |
___________________________________________________________________________________ ___________________________________________________________________________________ |
| Transportation / Housing / Volunteering (check
all applicable boxes) |
|||
| [ _ ] | Please help me find community housing | [ _ ] | I can provide community housing |
| [ _ ] | Please help me find transportation from the area | [ _ ] | I can provide transportation from the area |
| Reason for Request (Please briefly describe why you need a scholarship) |
___________________________________________________________________________________ ___________________________________________________________________________________ |
| Volunteering (How might you be able to assist with the conference?) |
___________________________________________________________________________________ ___________________________________________________________________________________ |
| Can you pay a partial fee and, if so, how much? _________________________________________ |
Please make check or money order payable to
Transcending Boundaries, Inc., and send to:
Transcending Boundaries, 1337 Massachusetts Ave. #132, Arlington MA
02476
For further information regarding registration:
email: tbc.reg@gmail.com