To Tell The Truth, Rhode Island, November 8, 1998
Workshop/Panel/Volunteer Registration Form
Download & Return by June 15, 1998

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Name__________________________________ Date_______________________

Organization________________________________________________________

Address____________________________________________________________

City_______________________________State_______ Zip__________________

Daytime Phone____________________Evening Phone______________________

Fax___________________________ Email _____________________________

Panel/Workshop Title_________________________________________________

Proposal (75 words)__________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

Audio-visual, other equipment needs_____________________________________

__________________________________________________________________

Presenter biography__________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

Would you be willing to present your workshop twice, during both morning and afternoon sessions? _______ yes ________ no

Would you be willing to moderate a panel? _______ yes ________ no

Volunteer Registration:

_____ I will volunteer before the event at Survivor Connections office, 52 Lyndon Road, Cranston RI
Please indicate when you are available (weekdays, weekends, day, evening etc.):

__________________________________________________________________

______ I will volunteer at the conference, Sunday, November 8:

_______ setup

_______ room monitor

_______ crisis support volunteer

_______ registration table

_______ resource table

_______ art/video exhibit monitor

_______ breakdown


All presenters and volunteers will receive a conference fee waiver. Please return this form before June 15, 1998 to:

Survivor Connections, Inc.
52 Lyndon Road
Cranston, RI 02905-1121
Phone (401) 941-2548, FAX (401) 941-2335


Thank you for your support!