Mom's Night Inn - Lincoln

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Mom's Night Inn - Lincoln - Registration

Feb 8 & 9, 2020- Please RSVP by January 30, 2020

Name *

Address *

City, State, Zip Code *

Phone Number *

Special Requests

Child's degree of hearing loss and additional concerns

Do you need an interpreter?

Spanish

Sign Language

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 23, 2020. Please let us know if you will need any additional accommodations.

Registration Fee (check one) *

$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 *

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 pay on the Nebraska Hands & Voices 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, January 23, 2020. 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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