Registration form for the 2001 North American Conference on Bisexuality, Gender, and Sexual Diversity
August 9th-12th, 2001 at the University of British Columbia Conference Centre, Vancouver BC Canada

Return this form with appropriate payment to
NACB 2001
c/o The Centre
1170 Bute St.
Vancouver BC

Or fill in your credit card information an email to  binetbc@bi.org

***Part one  Personal Information

Name
Address
City
State/Province
Zip Code
Phone number
Email Address

Name you would prefer on your conference badge

***Part 2  Conference Fees  (circle whichever applies)

Early Bird  Before February 28th, 2001
$US - 55
$CAN - 75
MXP - 468

Regular 
$US - 75
$CAN - 99
MXP - 625

Day of Conference
$US - 99
$CAN - 120
MXP - 758

Method of Payment

____Check(s) or money order enclosed.  (Payable to NACB 2001)

____Visa - Card # and expirey date  

Instalment plan (early bird and regular only)  Payment may be made in the form of two alternately dated checks.  In order to qualify for early-bird pricing, both checks must be dated prior to Nov. 30th, 2000.

Conference Accessibility Policy  Everyone is welcome a this conference regardless of the ability to pay.  If you cannot afford these fees, please speak to our Accessibility Coordinator who will be happy to work out an alternate arrangement.  All information shared with the Accessibility Coordinator is strictly confidential.  To reach the Accessibility Coordinator, email access2001@planetout.com or fax 604-875-8878

***Part 3  Conference Accessibility

I need assistance with  (check all that apply)

____Sign language interpretation

____Visual guide

____Child care

____Language interpretation  (which one?)

____Other (please specify)


I can assist with (check all that apply)

____Sign language interpretation

____Visual guide

____Child care

____Language interpretation  (which)

____I can provide accommodation in the Vancouver area for ____ people


***Part 4  Get involved!

____Please send me _____brochures and ____ posters to distribute in my area

____I'd like to help out during the conference

____I'd like to be part of the organizing team in the area of

Conference Accessibility notes  
The conference venue is wheel chair accessible and the conference time-table is being planned with accessibility in mind.  We anticipate sign having sign language interpretation throughout the conference but please help us be certain  your requirements are met but checking the box to the left  if you require it.  For more in formation on conference accessibility, visit our web page at http//bi.org/~binetbc/2001/access.htm, fax 604-875-8878 or email access2001@planetout.com.