REGISTRATION FORM
North American Invitational Summit: Bonding and Attachment in the Family
 March 27-30, 2003—La Casa de Maria, Santa Barbara, California

Name 	Degree(s) to be listed ___________
Title _____________Organization name	(if part of address listed below)

Address	
		Street/POB		City	
	Invited by:(if self, leave blank) ______________
State/Province	ZIP/Postcode	Country (if not US)
Phone(s) 	
Email (*required*) _________________________ Name to be called (large print on badge) 	
Bringing a poster for the poster session entitled	

Conference Tuition (includes 3 lunches and 3 dinners)
Postmarked by Feb 25, 2003 $435, Postmarked after Feb 25, $485		 $ 	
Dietary preference: __Vegetarian; __Vegan; __Regular (includes fish/poultry/dairy) Contact registrar for other special diet needs.

Continuing Education Credits (30hrs +3hrs/workshop) for: __RN; __LVN; __MFT; __LCSW ($25)	 $ 	

Lodging/Transportation
___ I would like on-site lodging at La Casa Conference Center (total for all 3 nights) 	 $195 (single)	 $ 	
___ I am staying at: _________________ Need ride from airport, arriving Thurs. at ________am/pm

Day-Use Fee--if you are not staying at La Casa, please add $10/day  ($30)	  	     $ 	

Breakfast at La Casa (reservations required)
___Friday      ___Saturday       ___Sunday       ($10 each)		Breakfast total:         $ 	 

Optional Scholarship Fund Contribution Your tax-deductible contribution will help determine the number of scholarships offered in order to enhance the economic and ethnic diversity of participants. 
___$50       ___$150       ___$435       Other $________			 $ 	
If you need a scholarship, contact the registrar, briefly stating your needs and reasons.
Post-Summit Workshops, Monday $60 each plus room or day use (below) 	$	
Please indicate your choices for both the morning and afternoon sessions by ranking any that you would like to attend (use 1,2,3 etc.). You will be given your first choices except if a workshop does not fill (full refund if none that you’ve indicated are provided).
Morning Workshops:				Afternoon Workshops: (see full descriptions on website)
___ Suzanne Arms: Creating a Sustainable Life… 	___ Wendy Anne McCarty: Being with Babies in Transformational Ways
___ Susan Campbell: Getting Real with Children and Teens (I)..	___ Susan Campbell: Getting Real with Children… (Part II--requires Part I)
___ Michel Odent: Can Humanity Survive Obstetrics?	___ Charlotte Peterson: Lessons from Around the World
___ Sobonfu Some: Welcoming Our Spirit 	___ Chief Sonne Reyna: Ceremonial Family Bonding
___ Stan Tatkin: Toward a Model of Prevention 	___ Barbara Wishingrad: The Rebozo Way of Life
Post Summit Facility/Room/Meals Please check each applicable and total: __$65 room Sunday OR 
__$10 Monday day use fee; __$15 Sunday dinner; __$10 Monday breakfast; __$13 Monday lunch Total:	 $  	
Total Payment  	 $ 	 
___ Check or money order (payable to aTLC) enclosed. ___ Paid online with credit card via PayPal.
If you are unable to attend, please let us know as soon as possible. Since the number of participants at the summit is limited, there are no refunds unless someone is able to fill your space. Regardless, a $50 processing fee will be retained.  

SEND FORM TO:  	Alliance for Transforming the Lives of Children
	Donna Worden, Registrar	831-338-0818
	544 Debbie Court	Fax:  801-904-8032 (yes, it really is 801)	
Thank you!	Boulder Creek, CA 95006 	signup@atlc.org (for returning as a word processor document)
Rev 1-20-03					
aTLC Summit Registration Instructions

1. Complete the registration form (attached)

2. Determine your payment method:

1.	Mail check or money order (payable to aTLC) along with your registration form to the address below, or
2.	Pay via PayPal from your checking account or credit card (we cannot accept credit cards any other way) using the link <www.atlc.org/members/summit1/register.php>.

PayPal Instructions:
a.	Log in to your account with the link directly above --if you are not already a PayPal member, you'll need to sign up (upper right side of page),
b.	If you want to use your credit card, and you've not already registered it, click on "Activate Account/Add credit card" (upper left corner),
c.	Click on the "Send Money" blue tab at top of page,
d.	Type "info@atlc.org" for “recipient's email address,”
e.	For the line "Type," select "Service" from the dropdown menu,
f.	Type "Summit Registration" in the "Subject" field, and your name and postal address in the "Note" field,
g.	Forward your registration form to us as an email attachment to: summitregistration@atlc.org, fax to 801-904-8032, or send via snail mail to the address below.

3. We will send acknowledgement summit updates as they become available.

4. Email address: If you do not have one, please find a friend willing to let you use theirs, or go to your library and set up a free account on hotmail or yahoo—we need to be able to update you regularly by email before the event. Thanks

If you have difficulties registering, please send an email to:

signup@atlc.org

or call Donna, 831-338-0818.

Special Summit Registration Address:
Alliance for Transforming the Lives of Children
Donna Worden, Registrar
544 Debbie Court
Boulder Creek, CA 95006