Please fill in all the necessary fields. Donating members must be logged in when completing your registration in order to get your conference discount (click here for Member Login or click here to join now).
Logged-in Members: Before you proceed with the registration, please confirm that your Membership Description is correct by opening the "Account" link at the bottom of the blue box to the left. If you believe that your Membership Description is inaccurate for the year, please email webmaster@nodcc.org with your name, membership donation amount, and the date on which it was submitted. We will update your membership accordingly and notify you when your account is ready for online registration.

If you prefer to donwload a PDF of the Registration Form to fax or mail, please click here:

Disorders of the Corpus Callosum Conference 2010 Registration Form

Conference Attendee Information Required Fields*

#1 Adult First Name*	Adult Last Name*	T-Shirt Size: Select Adult S Adult M Adult L Adult XL Adult XXL	DCC:
		Saturday Dinner - Attending Pizza Party and Dance Saturday Lunch Preference: Select Meat Sandwich Salad
#2 Adult First Name	Adult Last Name	T-Shirt Size: Select Adult S Adult M Adult L Adult XL Adult XXL	DCC:
		Saturday Dinner - Attending Pizza Party and Dance Saturday Lunch Preference: Select Meat Sandwich Salad
#3 Adult First Name	Adult Last Name	T-Shirt Size: Select Adult S Adult M Adult L Adult XL Adult XXL	DCC:
		Saturday Dinner - Attending Pizza Party and Dance Saturday Lunch Preference: Select Meat Sandwich Salad
#1 Child First Name	Child Last Name	T-Shirt Size: Select Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large	Age:
		Saturday Dinner - Attending Pizza Party and Dance Saturday Lunch Preference: Select Meat Sandwich PB & J Sandwich DCC Send Kids & Teens Camp Registration
#2 Child First Name	Child Last Name	T-Shirt Size: Select Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large	Age:
		Saturday Dinner - Attending Pizza Party and Dance Saturday Lunch Preference: Select Meat Sandwich PB & J Sandwich DCC Send Kids & Teens Camp Registration
#3 Child First Name	Child Last Name	T-Shirt Size: Select Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large	Age:
		Saturday Dinner - Attending Pizza Party and Dance Saturday Lunch Preference: Select Meat Sandwich PB & J Sandwich DCC Send Kids & Teens Camp Registration
#4 Child First Name	Child Last Name	T-Shirt Size: Select Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large	Age:
		Saturday Dinner - Attending Pizza Party and Dance Saturday Lunch Preference: Select Meat Sandwich PB & J Sandwich DCC Send Kids & Teens Camp Registration
Address*		City*
State/Province*	Zip/Postal Code*	Country*
Home Phone*	Cell Phone	E-mail*

Registration Options
Choose one of the following registration options for each person attending. No registration fee required for children under the age of 3 years. Childcare IS NOT AVAILABLE for children under the age of 3 years. Join the NODCC now to save on conference registration. For details see NODCC Membership benefits.

OPTION 1 (3-Day Conference Friday, Saturday, Sunday): Registration includes lectures, discussions, Friday dinner, Saturday & Sunday lunch, Saturday Evening Pizza Party & Dance, and Kids & Teens Camps.

OPTION 2 (2-Day Conference Saturday, Sunday): Registration includes lectures, discussions, Saturday & Sunday lunch, Saturday Evening Pizza Party & Dance, and Kids & Teens Camps.

 

NODCC Membership Discounts on Option 1 Conference Registration Fees

• $45 Sustaining: 10% discount for one person ($18.50 savings)
• $100 Growth: 10% discount for one person ($18.50 savings)
• $150 Progress: 15% discount for one person ($27.50 savings)
• $250 Momentum: 15% discount for one person ($27.50 savings)
• $500 Leadership: 15% discount for two person ($55.50 savings)
• $1000 Guiding: Free admission for one person ($185.00 savings)

	# Attending*		Option 1 After June 15	Option 2 After June 15	Option 1 Through June 15	Option 2 Through June 15
Adult per person (age 18+)		x	$210 USD	$185 USD	$185 USD	$165 USD	=
Teen per person (age 13-17)		x	$210 USD	$185 USD	$185 USD	$165 USD	=
Child per person (age 3-12)		x	$210 USD	$185 USD	$185 USD	$165 USD	=
	Note: Select 0 even if no one is attending in the age group. Example: If no attendees between age 13 - 17 type a 0 (zero) in the Attending field. Hint you will add a number for each of the three fields.				Sub Total		=
					Minus Membership Discount		=
					Total Amount Due		=

If you did not receive the conference discount that you expected, please stop your registration now and email webmaster@nodcc.org with your name, membership donation amount, and the date on which it was submitted. We will update your membership accordingly and notify you when your account is ready for online registration.

 

Cancellation Policy
Please register no later than June 1, 2010 to ensure admission and early bird rate. Registrations must be received in the NODCC Main Office no later than July 15, 2010. Thereafter, registration will be available only at the door for $275.00 per person and will not include meals. 90% cancellation refund if requested in writing prior to June 1, 2010. 50% cancellation refund if requested in writing between June 1 and July 15, 2010. No refunds for cancellations received after July 15, 2010.

 

DCC Conference Participation Waiver of Liability and Hold Harmless Agreement

All attendees are required to sign the following Participation Waiver of Liability and the Photography & Videotaping Release. Parents/Guardians must sign forattendees under age 18. Guardians must sign for attendees over age 18 as applicable.

I / We, the undersigned participant(s), have agreed to participate in the Disorders of the Corpus Callosum (“DCC”)
Conference 2010 that begins on July 30, 2010 and ends on August 1, 2010. The National Organization for Disorders of the Corpus Callosum, (“NODCC”), a Minnesota non-profit organization headquartered in the State of California, United States of America, is dedicated to working with individuals diagnosed with a Disorder of the Corpus Callosum and their families. This document shall be interpreted under and pursuant to the laws of the State of California.

Knowing, understanding, and fully appreciating all risks, I hereby expressly, voluntarily, and willingly assume all risks associated with my participation in the conference, including any and all losses, claims, or actions for any damages, theft, personal injury, sickness, disease, or death. The undersigned will pay any and all judgment decrees and costs, including attorney fees which may be rendered against or incurred by the DCC Conference 2010 organizers, volunteers, agents, exhibitors, or vendors in all actions or proceedings brought or caused by me / us.

The undersigned hereby expressly and unconditionally waives and releases the NODCC and all of its parents, subsidiaries, affiliates and partnerships, and their respective officers, directors, shareholders, partners, agents and employees, and their respective successors, heirs and assigns and each of them (individually and collectively, the “Released Parties”) from any and allrights and claims against the NODCC and/or the Released Parties with respect to my participation and involvement in the DCC Conference 2010, including but not limited to any alleged or actual negligence and intentional conduct or omissions to the maximum extent allowed under law.

Any dispute or claim in law or equity arising out of this Waiver and Hold Harmless Agreement shall be decided by neutral, binding arbitration, except as provided by California law for judicial review of arbitration. The arbitration shall take place in the County of Los Angeles, State of California, in accordance with the rules of the American Arbitration Association.

Photography, Videotape, Audiotape Release Authorization
I / We, the undersigned participant(s), acknowledge that my / our image(s) may be photographed, videotaped and/or audio-taped during the course of the Disorders of the Corpus Callosum Conference 2010. I / We give permission for my / our photographed and videotaped image(s), audio recorded and printed survey comments during the DCC Conference to be printed, posted and/or published in official
publications of the NODCC, including but not limited to directories, brochures, website, announcements, and conference materials.

By selecting the check box on this document I / we intend to bind not only myself / ourselves, but also my / our successors, heirs, representatives, administrators, and assigns.

First Name*	Last Name*	I Agree*
First Name	Last Name
Agreeing for the Following Family Members:
First Name	Last Name
First Name	Last Name
First Name	Last Name

 

Personal Name & Contact Information Release Authorization

	I give permission for my name, city, state, country, phone, and email address to be shared with members of the NODCC Community, and provided to newly diagnosed families seeking connections with other families.
	I give permission for our contact information (phone number and email address) to be shared with other conference attendees.
	I would like to receive a Certificate of Completion for the hours that I attend the conference. I understand that NODCC will not be providing Continuing Education Credits.
	I am interested in participating in DCC research projects to be conducted during the conference. Please contact me with information.

 

Amount:	$
Credit Card Type:	Visa Master Card American Express
First Name on Card:	Last Name on Card:
Credit Card Number:
Credit Card Expiration:	January February March April May June July August September October November December 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Credit Card Security Code: What's this?

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