REGISTRATION FORMCALIFORNIA WOMEN’S AGENDA (CAWA) CALL TO ACTION
A Leadership Summit and Policy Forum
Friday, April 3, 2009, 6:00 PM – Sunday, April 5, 2009, Noon,Visalia, California
CAWA is a program of Women’s Intercultural Network (WIN)
Please print legibly Complete a separate form for each participant, including scholarship applicants (download and print copy)
Participant's Name _________________________________________
Organization ______________________________________________
Address City/State ZIP ______________________________________
Phone Fax E-Mail __________________________________________REGISTRATION FEES: (Please Reply by March 27, 2009
I will attend: Three days , $50.00______ Fri. Reception only: $10.00______Sat. only: $30 ______ Sun. only: $15 _____
Registration fees include conference materials, Friday reception, Saturday lunch and dinner, Sunday continental breakfast
If registration is canceled after March 27, fees cannot be returned.
Enclosed is my registration fee in the amount of : $ ____________Enclosed is my organization's co-sponsorship for $25 ___ $100___ Other___ In name only___
Enclosed is an additional contribution to scholarships and stipends: $ ____________
Date: _________________TOTAL AMOUNT ENCLOSED $ ____________
Method of Payment:
By check, PayPal, or money order, made payable to: WIN (Women's Intercultural Network) Address below.
Payment is tax deductible to the extent allowed by IRS regulations. IRS # 94 3204314
By credit card: Mastercard _______ Visa _______ Expiration Date: __________
Card Number: _______________________________CVV2# (last 3 numbers on back of card):_______
Name of Cardholder (Print clearly) _______________________________________________
Signature of cardholder _________________________________________________________
HOUSING: CAWA is holding a block of rooms at the Marriott Visalia Hotel, 300 Court St, Visalia, with a special rate of $109 + tax. One to four people may reserve a room for that rate! Reserve your rooms at: 559-636-1111, Reservation Code : cawcawa
If you are interested in a home-stay, please check here and return with Registration by March 23rd _______
If you are willing to host a conference participant in your home, please check here________
Name______________________________________________________ Phone # ________________
For nature lovers, Friends Meeting House grounds are beautiful in the Spring and open for camping out – bring your tent, or your sleeping bags for inside the Meeting House. Check here if you choose that option ________
TRAVEL: Travel green – take the train! Amtrak offers a 10% discount off the lowest available rail fare to (Visalia, CA) between (March 31, 2009 – April 8, 2009). To book your reservation call Amtrak at 1 (800) 872-7245 and use CAWA Convention Fare code: X51W-959 (Convention fares cannot be made on-line)
DOWNLOAD FORM AND SEND PAYMENT TO: WIN (Women's Intercultural Network),
1950 Hayes St., #2, San Francisco, CA 94117 or FAX TO: WIN at 415-373-3932FOR INFORMATION: Mimi Formosa, CAWA Field Coordinator: 408-298-3798, Graciela Martinez, Proyecto Campesino: 559-733-4844, Robyn Flores, ACT: 559-799-6716, WIN: 415-221-4841