Mom's Night Inn Lincoln - Registration
March 27 & 28, 2021 ** we will be strictly following the CDC recommendations for this event.
Name *
Address *
City, State, Zip Code *
Phone Number *
Email
Special Requests
Child's degree of hearing loss and additional concerns, please include child's age.
Do you need an interpreter?
Sign language interpreting services are available and are free of charge. Services will be provided but will not be guaranteed if requests are not made by March 1. Please let us know if you will need any additional accommodations.
Registration Fee (check one) *
Please Check one *
My Regional Program is:
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Payment
Please submit payment on our website. If you would like to be considered for a scholarship, please contact Shelli Janning janning4@hotmail.com or call 402-533-8915. Deadline for Scholarship applications, March 12, 2021. Scholarships are limited so please request ASAP if interested.
Registration Fee Options *
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