BREAKING THE SILENCE NETWORK ANNUAL MEETING IN OUR 26TH YEAR!
FRIDAY, JUNE 12TH, 7 PM – SUNDAY, JUNE 14th, 1 PM

Please return this form ASAP by Email only, no later than Friday, June 5th to Ann Manicom, annmanicom(at)gmail.com ***The earlier you register, the more helpful it is to Tatamagouche Centre and BTS.

Bursary applications must arrive by Friday, May 29th. Please do not stay away because of lack of funds! We need your presence and we have a Bursary Fund. (See below.)

Name ________________________________________ E- mail ____________________________

Mailing Address _________________________________________________

Phone ____________________________ ***Please note: Registration of children is below. Each adult should fill in an individual form, and indicate if you wish to room together.
ACCOMMODATION AND MEALS Please choose one option. Please also note that we ask all participants to pay a registration fee of $32 whether or not you are able to stay for the entire weekend.
A. __ I am staying at Tatamagouche Centre Fri. night to Sun. noon Total cost, $176.50, Camping $136.50. (Campers must supply their own bedding, pillows, towels. Bathroom/shower facilities will be designated.)
Please indicate whether you are willing to stay in Campbell House, where the Sat. night fiesta may take place (til about 1am or later, most likely).
___ Yes, I am willing to stay in Campbell House.
___ No, I prefer to be assigned elsewhere.

___ I plan to camp.

If you wish to room with a specific person, please indicate. ______________________
B. __ I am not staying at Tatamagouche Centre, and will pay for meals that I take.
Please indicate what meals you will be eating at Tatamagouche Centre. (If sufficient food is available, you may purchase additional meals. However, the kitchen appreciates approximate numbers in advance.) ***Please note that we ask all participants to pay for snacks.

Sat. breakfast $7___, snack $2.50____, noon meal $13.50 ___, snack $2.50___, supper $11 ___,snack __$2.50

Sun. breakfast $7 ___, snack $2.50, noon meal $13.50___

Billeting: ___ I would prefer to be billeted, if possible..

C. __ Other option e.g. Staying only Fri. night or Sat. night. Please describe.

MENU CHOICE
Regular menu _____ Vegetarian ___ (will eat fish ___, will eat chicken ___)
***If you have severe dietary restrictions, please consider bringing your own food.

BURSARY FUND CONTRIBUTION We ask those who are able to do so to consider a contribution to the BTS Bursary Fund. I am able to contribute $____.

BURSARY APPLICATION Please indicate how much bursary assistance you need. ¬$___ We ask each person to attempt to pay a minimum of $32, more if you can. Please do not stay away because of lack of funds. We need your presence!

CARPOOLING BTS encourages carpooling, including pick-ups along the way (eg someone coming from Fredericton picks up someone in Moncton.) Please indicate:

___ I have a car. I can take __ persons with me.

___ I need a lift from _______________.

CHILD REGISTRATION Child care will be provided free of charge.
Please indicate the name and age of each child accompanying you. ***Costs for children: Under two years Free. 2-12-years, 55% of adult fee for meals, accommodation. 13 and above: Adult accommodation and meals costs.
1. Name ________________________________________Age ______ Needs child care _______

2. Name ________________________________________Age ______ Needs child care _______

3. Name ________________________________________Age ______ Needs child care _______