Mom's Night Inn Lincoln - Registration
February 8 & 9, 2020
Name *
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Address *
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City, State, Zip Code *
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Phone Number *
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Special Requests
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Child's degree of hearing loss and additional concerns
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Do you need an interpreter?
Sign language and Spanish interpreting services are available and are free of charge. Services will be provided but will not be guaranteed if requests are not made by January 16. Please let us know if you will need any additional accommodations.
Registration Fee (check one) *
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My Regional Program is:
Please submit payment on our website. If you would like to be considered for a scholarship, please contact Shelli Janning or call 402-533-8915. Deadline for Scholarship applications, January 16, 2019. Scholarships are limited so please request ASAP if interested.
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