Mom's Night Inn Lincoln - Registration
March 27 & 28, 2021 ** we will be strictly following the CDC recommendations for this event.
* Required
Name
*
Your answer
Address
*
Your answer
City, State, Zip Code
*
Your answer
Phone Number
*
Your answer
Email
Your answer
Special Requests
Your answer
Child's degree of hearing loss and additional concerns, please include child's age.
Your answer
Do you need an interpreter?
Sign Language
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)
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$40 I am a member of Nebraska Hands and Voices, I will need a single room
$50 I am not a member of Nebraska Hands & Voices; I will need a single room
$20 I plan to attend the event but I will not be staying the night; I am a member of Nebraska Hands & Voices
$25 I plan to attend the event but I will not be staying the night, I am not a member of Nebraska Hands & Voices
Please Check one
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I have attended before. I understand we will start promptly at 1:00
I have not attended before. I understand we will start promptly at 1:00
My Regional Program is:
CWNP (Sarah, Heather)
NRP
MRP
SNRP
Clear selection
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
*
I will pay on the Hands & Voices Wesbite
I will be requesting a scholarship by calling Shelli 402-533-8915 or e-mailing Shelli at
janning4@hotmail.com
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