Conference Registration Form


All registrations must be received by the NODCC Main Office no later than June 5, 2018. Thereafter, registration will be available only at the door for $450.00 per person and will not include meals. 90% cancellation refund if requested in writing prior to April 15, 2018. 50% cancellation refund if requested in writing between April 16 and June 1, 2018. No refunds for cancellations received after June 1, 2018. Please note the NODCC Central Office will be closed June 25 through July 6, 2018 as staff will be in Costa Mesa, CA to handle conference pre/post planning. However, staff will respond to email to the NODCC and phone inquiries.

Please click here to download the form Conference Registration Form

1# Adult First Name :
?

Please enter adult first name

Adult Last Name :
?

Please enter adult last name

T-Shirt Size Adult Small Medium Large X Large 2X Large 3X Large
DCC   Attend Pizza Party Special Dietary Needs    

2# Adult First Name :
?

Please enter adult first name

Adult Last Name :
?

Please enter adult last name

T-Shirt Size Adult Small Medium Large X Large 2X Large 3X Large
DCC   Attend Pizza Party Special Dietary Needs    

3# Adult First Name :
?

Please enter adult first name

Adult Last Name :
?

Please enter adult last name

T-Shirt Size Adult Small Medium Large X Large 2X Large 3X Large
DCC   Attend Pizza Party Special Dietary Needs    

1# Child First Name :
?

Please enter child first name

Child Last Name :
?

Please enter adult child last name

T-Shirt Size Child Small Medium Large Adult Small Medium Large
DCC Kids/Teens Camp Registration        
    Attend Pizza Party Special Dietary Needs

2# Child First Name :
?

Please enter child first name

Child Last Name :
?

Please enter adult child last name

T-Shirt Size Child Small Medium Large Adult Small Medium Large
DCC Kids/Teens Camp Registration        
    Attend Pizza Party Special Dietary Needs

3# Child First Name :
?

Please enter child first name

Child Last Name :
?

Please enter adult child last name

T-Shirt Size Child Small Medium Large Adult Small Medium Large
DCC Kids/Teens Camp Registration        
    Attend Pizza Party Special Dietary Needs

4# Child First Name :
?

Please enter child first name

Child Last Name :
?

Please enter adult child last name

T-Shirt Size Child Small Medium Large Adult Small Medium Large
DCC Kids/Teens Camp Registration        
    Attend Pizza Party Special Dietary Needs
Address :
?

Please enter address

City :
?

Please enter city

Country :
?

Please select country

State :
?

Choose something or choose not. what shall it be?

Zip :
?

Please enter zip

Home Phone :
?

Please Enter Phone Number

Cell Phone :
?

Please Enter Phone Number

Email
(Confirmation & other info will be emailed, not mailed)
:
?

Please enter email

REGISTRATION OPTIONS (Choose one of the following registration options for each person attending)

(3-Day Conference Fri, Sat, Sun) Registration includes lectures, discussions, Fri lunch, Fri dinner, Sat & Sun lunch, Sat Pizza Party, Kids & Teens Camps

No registration fee required for children under the age of 3 years. Childcare IS NOT AVAILABLE for children under the age of 3 years

Join the NODCC now to save on conference registration. For details see www.nodcc.org
NODCC Membership Discounts on Conference Registration Fees
$ 100 Growth: 10% discount for one person ($27.50 savings)   $ 500 Leadership: 25% discount for one person ($68.75 savings)
$ 250 Momentum: 20% discount for one person ($55.00 savings)   $ 1,000 Guiding: Free admission for one person ($275.00 savings)
     
  # Attending   Early Bird Rate
Before March 15th
  March 16 - May 25
Adult per person (age 18+) X $ 275.00 USD $ 325.00 USD
Teen per person (age13-17) X $ 275.00 USD $ 325.00 USD
Child per person (age 3-12) X $ 275.00 USD $ 325.00 USD
           
           
  # Attending   May 26 - June 5   At the Door
Adult per person (age 18+) X $ 375.00 USD $ 450.00 USD
Teen per person (age13-17) X $ 375.00 USD $ 450.00 USD
Child per person (age 3-12) X $ 375.00 USD $ 450.00 USD
Sub Total = $
Minus Membership Discount = $
Total Amount Due = $
PAYMENT OPTIONS All payments must be made in US dollars. We cannot accept checks or money orders drawn from banks outside the U.S.A.
Paypal Check or Money Order Enclosed – Payable To: NODCC

Attendees are required to sign the liability release on the back of form. Parents/Guardians must sign for those under age 18.

CANCELLATION POLICY

Please register no later than March 15, 2018 to ensure admission and early bird rate. All registrations must be received in the NODCC Main Office no later than June 5, 2018. Thereafter, registration will be only available at the door for $450.00 per person and will not include meals. 90% cancellation refund if requested in writing prior to April 15, 2018, 50% cancellation refund if requested in writing between April 16, 2018 and June 1, 2018. No refunds for cancellations received after June 1, 2018.

DCC CONFERENCE PARTICIPATION WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT

All attendees are required to sign the following participation waiver of liability and photography & videotaping release. Parents/Guardians must sign for attendees under age 18. Guardians must sign for attendees over age 18 as applicable.

I / We, the undersigned participant(s), have agreed to participate in the Disorders of the Corpus Callosum (“DCC”) Conference 2018 that begins on June 29, 2018 and ends on July 1, 2018. The National Organization for Disorders of the Corpus Callosum, (“NODCC”), a Minnesota non-profit organization headquartered in the State of California, United States of America, is dedicated to working with individuals diagnosed with a Disorder of the Corpus Callosum and their families. This document shall be interpreted under and pursuant to the laws of the State of California.

Knowing, understanding, and fully appreciating all risks, I / We hereby expressly, voluntarily, and willingly assume all risks associated with my participation in the conference, including any and all losses, claims, or actions for any damages, theft, personal injury, sickness, disease, or death. The undersigned will pay any and all judgment decrees and costs, including attorney fees which may be rendered against or incurred by the DCC Conference 2018 board, membership, organizers, volunteers, agents, exhibitors or vendors in all actions or proceedings brought or caused by me / us.

The undersigned hereby expressly and unconditionally waives and releases the NODCC and all of its parents, subsidiaries, affiliates and partnerships, and their respective officers, directors, shareholders, partners, agents and employees, and their respective successors, heirs and assigns and each of them (individually and collectively, the “Released Parties”) from any and all rights and claims against the NODCC and/or the Released Parties with respect to my participation and involvement in the DCC Conference 2018, including but not limited to any alleged or actual negligence and intentional conduct or omissions to the maximum extent allowed under law.

Any dispute or claim in law or equity arising out of this waiver and hold harmless agreement shall be decided by neutral, binding arbitration, except as provided by California law for judicial review of arbitration. The arbitration shall take place in the County of Orange, State of California in accordance with the rules of the American Arbitration Association.

PHOTOGRAPHY, VIDEOTAPE, AUDIOTAPE RELEASE AUTHORIZATION

I / We, the undersigned participant(s), acknowledge my / our image(s) may be photographed, videotaped and/or audio-taped during the course of the Disorders of the Corpus Callosum Conference 2018. I / We give permission for my / our photographed and videotaped image(s), audio recorded and printed survey comments during the DCC Conference to be printed, posted and/or published in official publications of the NODCC including but not limited to directories, brochures, website, announcements, and conference materials.

My / Our signature(s) on this document is intended to bind not only myself / ourselves, but also my / our successors, heirs, representatives, administrators, and assigns.

PERSONAL NAME & CONTACT INFORMATION RELEASE AUTHORIZATION
I give permission for my name, city, state, country, phone, and email address to be shared with members of the NODCC Community, and provided to newly diagnosed families seeking connections with other families.
I give permission for our contact information (phone number and email address) to be shared with other conference attendees.
I am interested in participating in DCC research projects to be conducted during the conference. Please contact me with information.

Mail: (Credit Card, Check, Money Order) NODCC, PMB 363, 18032-C Lemon Drive, Yorba Linda CA 92886 USA

Scan & Email (Credit Card Only) conference@nodcc.org

Register Online: www.NODCC.org Questions or Further Information: Phone 714-747-0063 Online: conference@nodcc.org

Back to top

NODCC CENTRAL OFFICE

PMB 363, 18032-C Lemon Drive, Yorba Linda, CA 92886
Phone: (714) 747-0063
Fax: (714) 693-0808
Email: info@nodcc.org
Privacy policy

Corpus Callosum Disorders   |   Newly Diagnosed   |   Resources   |   Research   |   Professionals   |   Donate

Get Involved   |   Conferences   |   Community   |   About NODCC   |   Contact

Designed by DKH Studios and Powered by MMediaWeb®

National Organization for Disorders of the Corpus Callosum   |   Copyright 2018   |   All Rights Reserved