Required fields are marked with a red asterisk (*)

Last Name:*
First Name:*
Address:*
Phone:*
Email:*

The Conference fee is $0 to $20 (whatever you can afford). Donations - to cover food and reimbursements for travel and childcare - are welcome.
I will pay fee/donate at the conference.
I will mail my fee/donation in advance (MAIN, P.O. Box 69, Hallowell, ME 04347).
I can't attend but will mail donation to help with expenses.

I need child care.

Number of children:
Ages of Children:

The child care space will be in the conference room at Maine Equal Justice at 126 Sewall Street right across the street from the State House. We hire qualified child care providers for this service. There is no cost to you for child care. Lunch provided.

Special needs:
Let us know if you (or a child you bring) have any special needs. We will do our best to accommodate you.

I need a meatless lunch.
Tell us about any other special needs requests here:

Request for Reimbursement:

I will need travel reimbursement.

Miles round trip:

MAIN encourages ride sharing whenever possible—it’s fun, saves on gas and creates less pollution.

I need a ride.
I can offer a ride to	people.

I can’t bring my child and will have to pay for child care myself.

Reimbursement amount requested $:

Choose one workshop you want to be in:
Face-to-face conversations
Public speaking
Phone calls
Letter writing

Questions? Contact Chris Rusnov at 1-866-626-7059 ext 204; e-mail: crusnov AT mejp DOT org