Convo Registration Form


Print out this form, fill it in, and mail it to: Convo 2002, 4021 W. 161 St., Cleveland OH, 44135-1237

Please include full payment by check or money order, payable to Interweave Continental, with the form!

Note - Canadian registrations must be paid in US dollars by money order only! We can’t process checks payable on Canadian banks...Sorry for any inconvenience.

Personal Information and Needs (for persons under 18 see release form below)

Name______________________________________ Address_______________________________________

City__________________________ State/Prov_____ Zip/Postal Code____________

Email____________________ Home Phone (____)______________ Work Phone (____)_____________

My UU Church____________________________________

My Food Preferences:

qVegetarian qVegan qOmnivorous  Note any dietary restrictions:__________________________________
qYes, I need child care! ($20 per child) # of children___________ Age(s)_____________

Fees (includes program, Friday dinner, and Saturday breakfast and lunch)
Interweave Member--$105_____ Non-member--$120_____ Sunday Lunch -- $20 _____

q I want to join Interweave! For only $30 a year, I can pay the reduced price for Convo, plus receive InterweaveWorld 3 times a year!! I’ll send in my $30 now!
q I need scholarship assistance      q I want to donate to a scholarship fund! Amount $_______

Total Enclosed $_____
Thank you for registering.  We hope you have a great time!

For registrants under 18: All youth under 18 must attend Convo with a parent or other adult sponsor who is also registered for the conference. 

My sponsor/parent is _____________________________________ Their phone_________________

Parent/guardian(s), please read and sign: I give my child, _______________________________ permission to attend Convo in Las Vegas, Nevada, February 15-17, 2002.  I give my permission for my child's sponsor, ___________________________ ,to provide supervision and make any emergency medical or legal decisions on my behalf.  I understand that the organizers/staff of Convo will not be providing supervision of youth attendees, and I agree to hold them and the board of Interweave Continental harmless.