UNCG Center for Women's Health and Wellness Registration Form
8th Breastfeeding & Feminism Conference
March 21-22, 2013 Chapel Hill, NC

Department of Maternal and Child Health
Gillings School of Global Public Health
University of North Carolina
Chapel Hill

* Required items  
Step 1: Name/Address
First-time attendee? Yes    No
*First name
*Last name
*Gender Female Male
*Birthdate MM/DD/YYYY
We ask that you provide your birthdate and gender with the understanding that they will be used only as identification for internal record keeping and data processing operations at the University of North Carolina at Chapel Hill.
Badge name
(if different from above)
Job title
Degrees
(maximum 3)
*Organization
Check one Home address    Work address
Mailing address
City
State or country
Postal code
*Daytime phone
Fax
*Email

(should match email used to submit abstract)
Step 2: Registration fees
Registration fee includes breakfast and lunch buffets both days and reception on March 21. All meals offer vegetarian and gluten free options.

Do you need a Kosher meal?
Yes    No
*Registration Fees: Early
Received by

1/18/2013
Regular
Received by
2/28/2013
Late
Received
After 2/28/2013
Regular Attendee$295$350$375
Student$100$125$150
NOTE: All exhibitors must be Code of Marketing compliant.
Exhibitor (for profit)
(Includes one full registration)
$400$450$525
Exhibitor (non-profit)
(includes one full registration)
$330$395$425
CEUs$15$15$15
CERPs$0$0$0
IBCLC number for CERPS
TOTAL REGISTRATION FEE: 
Step 3: Payment Information
Payment Method:

By mailing a check

Online by Visa or MasterCard
Please make checks payable to
"NC Institute for Public Health", and send to:
Cherelle Whitfield, Program Manager
CB# 8165, NCIPH,
Chapel Hill, NC 27599-8165.

Please include a copy of the acknowledgment page you
will see when you click "Submit registration" below.
Check number
Check amount

The acknowledgment page that follows will contain a
button to enable you to make your payment securely online.

Only Visa or MasterCard are accepted.
Step 4: Housing Information

The Breastfeeding and Feminism 8th Annual Conference will be held at the Sheraton Chapel Hill, in Chapel Hill, North Carolina. A block of rooms is being held there at the conference rate of $99 for all occupancies. Call (800) 325-3535 or (919) 969-2174 and identify yourself as a participant of the Breastfeeding and Feminism Conference Rooms must be reserved by February 27, 2012 in order to guarantee the special meeting rate. Reservations can also be made online at Carolina Global Breastfeeding Institute; use the rate code BF&FEM.