• Registration includes access to all workshops and panels, buffet breakfast, fruit and juice bar and Friday & Saturday Night activities.
• Please fill out this form completely and legibly. (Photocopy for additional registrants)
• All registration must be postmarked by the deadline dates. Registration received after deadline dates will be counted as next level of payment and the registration will not be confirmed until extra payment is received.
• Returned checks will incur fees charged by bank plus an additional $15.00
• All fees must be received with registration

Regular

Day Pass

Student/
Senior Rate

Volunteer I

Volunteer II

Youth

Scholarship

$150

$75

$50

$75

$0

$30

$20

$175

$75

$75

$75

$0

$30

$30

$225

$75

$100

N/A

$0

$30

$N/A

Installment Plan: Must register and pay deposit of $50 by 8/27/06. Remaining payment due by 9/27/06. Any balance received after this date will be considered same day and be charged accordingly.

Group Rate: Take 15% off any group of 5 or more. Group must submit registration forms together with one check or charge. Not Applicable to Onsite registration.

Family rate: mother/daughter, father/daughter, wife/husband, grandparent/grandchild, aunt/niece, etc. – take $25 off combined registration. Must submit registration forms together. Not Applicable to Onsite registration.

Student: - an individual enrolled in any full time program(12 units or more) and must enclose photocopy of current student I.D. AND proof of student status (e.g. course schedule)

Senior: an individual 65 years or older and must enclose a copy of drivers license.

Youth rate: an individual registering for the 2-day Young Women’s Forum.

Volunteer I: an individual willing to work 8 – 10 hours over the 3 day weekend. Hours do not include mandatory volunteer orientation. * See volunteer guideline for details. 25 volunteers needed.

Volunteer II: an individual willing to be trained and work the entire 2-day Project Butterfly Youth Forum led by Niambi Jaha- Echols. There will be a mandatory training and orientations. * See volunteer guideline for details. 15 volunteers needed.

Scholarships: Any individual experiencing economic hardship is invited to submit a scholarship application. Individuals from the following categories are encouraged to apply and will be given priority: Women in recovery, women with large families, low-income women receiving government assistance, grandparents raising their grandchildren.

Refund Policy: Refunds, less a $30 processing fee will be granted if requested in writing no later than 9/15/06 and mailed to address below. No refunds after this day! You may however substitute someone else in your place. Refunds will available after October 24.

Note: For all registration that requires documentation, your registration will not be considered complete without it.
Note: Scholarship applicants must register by mail.

Online: Paypal
*Visa and Mastercard only   

1. Download and complete registration form
2. Make payment through Paypal
3. Include Paypal confirmation # on registration form
4. Fax, email or mail form back
5. Wait for confirmation.

Regular Early Bird Registration $150 until 8/27/06
Regular Registration $175 until 9/27/06
Student/ Senior Early Bird Registration $50 until 8/27/06
Student/ Senior Registration $75 until 9/27/06
Volunteer Rate $75
Youth Rate $30
Day Pass $75.00
Installement Option $50 now! Remainder due by 9/27/06
Support our efforts! Donate to Muhsana!

By Fax : (510) 835-0349
*Visa and Mastercard only

1. Download and complete registration form
2. Include credit card info on the form. Check or money order can only be registered via postal mail only!
3. Fax, email or mail form back
4. Wait for confirmation.

By Phone: (510) 295-2553
*Visa and Mastercard only

Mail: Muhsana Center for Health & Healing
2625 Akcatraz Ave., #347
Berkeley, CA 94705

Email: conference@muhsana.org
*Visa and Mastercard only

In Person: Oakland YWCA
1515 Webster St., Downtown Oakland
*same day registration fee applies