Registration Form

Click here to download a printable PDF version of the HNA 2017 LATE REGISTRATION FORM. Complete the form and mail it — one copy for each registrant — together with your check for payment to:

      Cynthia Henderson, HNA Registrar
  2705 Ventoso
  Santa Fe NM 87505
  USA

US dollar checks should be made out to “Haiku North America 2017.”

(This version is for online viewing only)

HNA 2017 LATE REGISTRATION FORM
All prices are in US dollars.

HOW TO REGISTER: Please complete this form — one copy for each registrant — and send it by postal mail or e-mail it to HNA as in the instructions. Payments by US dollar check made out to "Haiku North America 2017," or payments via PayPal are accepted.

FULL CONFERENCE, September 13–17, 2017. Includes all presentations, lunches Thursday–Saturday,
the Saturday dinner barbecue, and one copy each of the HNA 2017 anthology and group photo $300
   —or--
DAILY ATTENDANCE. Includes all presentations and lunch as indicated and one copy of the conference anthology.
Circle or check options desired. Please place a check mark by the days you plan to attend:
_____ Wednesday, September 13. Includes opening ceremony, reception, and evening activities $40
_____ Thursday, September 14. Includes presentations, activities, and lunch $90
_____ Friday, September 15. Includes presentations, activities, and lunch $90
_____ Saturday, September 16. All presentations, activities, lunch, and evening reception & barbecue $180
_____        Presentations and lunch only (excludes evening reception & barbecue) $90
_____        Evening reception & barbecue only (excludes morning & afternoon presentations) $90
_____ Sunday, September 17. Morning presentations and closing ceremonies; Tanka Sunday free

OPTIONAL ITEMS
HNA 2017 T-shirts. Indicate number of each size: S ____ M ____ L ____ XL ____ XXL ____   @ $25 _____

HNA conference anthology, additional copies: please indicate the number of copies you want
in addition to the one free copy included with registration: ____ @ $10 _____

DONATE to HNA 2017. All donations are greatly appreciated and are tax-deductible in the US. _____

  TOTAL AMOUNT ENCLOSED: __________

                   Your Name       ________________________________________________________________
                   Street Address ________________________________________________________________
                   City / State / Province / Country _______________________ ZIP/Postal Code __________
                   E-mail _______________________________________________________________________
                   Phone ________________________________________________________________________

NOTE: The attendee list provided in your registration packet will include your name and city/country
(not your full address). We'll also include your e-mail address unless you check “No” here. _____

Click here to download a printable PDF version of the HNA 2017 REGISTRATION FORM to use if you're registering by postal mail.

MENU FOR PAYMENT BY PayPal

CONFERENCE REGISTRATION FEE

SOUVENIR T-SHIRTS

EXTRA COPY OF HNA ANTHOLOGY

DONATE TO HAIKU NORTH AMERICA
All donations are greatly appreciated and are tax-deductible in the US.
Note: your donation will be treated as a separate transaction by PayPal.