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POMC - Greater Orange County Chapter
Conference Registration Form
Conference Registration Form
Name 
POMC Chapter:
Mailing Address:
City State Zip Code
Phone Fax Email
Are you? Professional
Parent
Sibling
Spouse
Grandparent
Adult Child
Other:
Check if  First Conference
Newly Bereaved (within one year)
Special Assistance Required
Professional Attendee
Job Title:
Organization:

Full Registration Includes Five Meals (Make choices below).
EARLY REGISTRATION (Adult Survivor with meals) by May 30th
Adult (Survivor with meals) Conference Registration by June 30th
Professional Conference Registration with meals
Children (10 and under) with meals
Late Registration (After June 30th)
Partial Registration Options
Meals only
Friday Video Memorial Service with lunch
Saturday Night Awards Banquet with dinner
One Day Registration with meals. Friday Saturday
Late Registration (After June 30th)
Conference Registration without meals
$180.00
$210.00
$250.00
$125.00
$ 30.00

$150.00
$ 50.00
$ 75.00
$ 90.00

$ 30.00
$125.00
Total Conference Fees $
Meal Choices
  Vegetarian Kids Meal (Chef’s Choice)
Friday Memorial Video Lunch Turkey Sandwich Wrap Chicken Caesar Salad
Friday Dinner Sake-Seared Chicken New Orleans Chicken
Saturday Lunch Pesto Penne Pasta Primavera South of the Border Salad w/Flank Steak
Saturday Banquet Oven Roasted Mahi Mahi Roasted Half Chicken

Yes, I will be staying for Sunday Brunch and the closing ceremony.
No, I am unable to attend the Sunday events.
Additional Donation/Sponsorship
Please reserve # table(s) at $50.00 each.(Each $50 donation reserves 1 table of 10 for all 5 conference meals.)
$
I would like to sponsor a workshop. ($75.00 ea).
In memory of In honor of
Name:
$
I am enclosing a donation to support the Conference.
$
I am enclosing a donation for the Scholarship fund to help someone who could not otherwise attend.
$
Non Attendees:
Please light a candle in my loved one’s name ($5.00 ea)
$
Sub Total:
$
Memorial Service and Picture Wall Photos
Yes, I want my loved one’s photo included in the Memorial Video and on the Picture Wall. I am sending my loved one’s photo by June 30, 2008. I understand there is no charge for this memorial, but I do have to be present at the conference for my loved one’s picture to be included. I have labeled the photo and understand I should not send an original print as it will not be returned. I have printed clearly to avoid any misspellings by the conference committee.
Memorial Service and Picture Wall Photos
Love One's Name:
Age
Date of Murder
Memorial Book
You may design a special page or partial page with photos, names, dates, borders, poems, etc. There is a special 20% discount if you do the layout! Go to your local copy store and test the photo to ensure good reproduction before submission. Pictures will be included as submitted. Do not send originals! Photos will not be returned, but may be retrieved at the conference. Photos not retrieved at the conference will be forwarded to the National POMC Office. Submissions must be received by May 30, 2008. Late submissions will not be included in the Conference Memorial Book, but will be displayed on the Picture Wall. Please write your name, your loved one’s name, age, birth and death dates on the back of the photograph. Please print clearly to avoid any misspellings by the conference committee. Attendance is not necessary to have a picture posted on the Picture Wall.
Yes, I want to purchase a spot in the Memorial Book. I am sending my submission by May 30, 2008.
Love One's Name:
Age
Date of Murder
Size Quantity Price
Camera Ready
(20% Discount)
Total
Full Page $ 125.00
Half Page $ 65.00
Quarter Page $ 35.00
Total for Memorial Book
Conference T-Shirts (Pick up at Conference)
Size Quantity Price Total
Medium $ 15.00
Large $ 15.00
XL $ 15.00
XXL $ 18.00
XXXL $ 18.00
Sub Total
Total Due:
$