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Maine Association of the Deaf
Maine Association of the Deaf
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Interpreter Requests
ASL Immersion Registration Form
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Please enable JavaScript in your browser to complete this form.
Name
*
First
Last
Email
*
Phone Number
*
Phone Type
*
This phone number is a...
Videophone
Mobile
Text Only
Landline
Street Address
*
Town
*
Town
State
*
State
Zip Code
*
Zip Code
Emergency Contact Name
*
Emergency Phone Number
*
I am a...
*
pick one
Deaf Interpreter
Hearing Interpreter
Deaf Community Member
Family member of ASL user
Interpreting Student
ASL Student
Other
Which pass would you like to purchase?
*
Out of State Attendant - $250.00
Maine Hearing People - $200.00
Maine Deaf Community - $100.00
Maine ASL/ITP Students - $100.00
(Maine Deaf people have a discount because they are providing ASL for the immersion)
Do you want CEU's from this event?
Yes, I want CEUs! - $50.00
Your Identity and Pronouns
*
This is for internal use only to streamline cabin assignments. You can put in N/A if you do not want to answer.
Examples: he/his, she/hers, they/theirs -- cisgender, non-binary, gender neutral
Cabin Preference
Same Gender
Flexible or no preference
Family
We have 6 cabins with 90 beds in total, we will do our best to accommodate needs. Please let us know your additional concerns in the Comments/Questions box below. Our registration volunteer will reach out to you to provide assistance.
Shirt Size
*
Pick your shirt size
XS
S
M
L
XL
XXL
Free shirt for these who register and pay before September 1st!
Dietary Needs
Accessibility needs?
This is an ASL event - if you need accommodations please let us know and we will work with you.
Allergies
Have any allergies that we need to be aware of?
Comments or Questions
I would like to receive email updates regarding future conferences
Total
*
Order Summary
Item
Quantity
Total
There are no products selected.
Which pass would you like to purchase? - Out of State Attendant
1
$250.00
Which pass would you like to purchase? - Maine Hearing People
1
$200.00
Which pass would you like to purchase? - Maine Deaf Community
1
$100.00
Which pass would you like to purchase? - Maine ASL/ITP Students
1
$100.00
Do you want CEU's from this event? - Yes, I want CEUs!
1
$50.00
Cabin Preference - Same Gender
1
$0.00
Cabin Preference - Flexible or no preference
1
$0.00
Cabin Preference - Family
1
$50.00
Total
$0.00
$0.00
Credit Card Payment -- Processed by Stripe
*
Submit
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