Please fill in all of the fields below! Enter "NA" or "Not Applicable" in fields which do not apply to you.

GENERAL INFORMATION

First Name:

Last Name:

Street:

City:

State:
Select... Canada/Other Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware D.C. Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Mexico New Jersey New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip:

A phone number where we can reach you:

Email:
I do not have an email address:

STATION/ORGANIZATION AFFILIATION (optional)

Do you have a Low Power FM radio station on the air, or are you and/or your group trying to set up a Low Power FM station? yes no

Are you part of a full-power station, or are you trying to build one? yes no

What's the name of your organization? Fill in NA for 'not applicable' if you are on your own.

How many folks from your group are coming to Massachusetts? Fill in NA for 'not applicable' if you are on your own.

ATTENDANCE INFORMATION

On which days do you plan to attend the conference? Please check all boxes that apply!

The whole event -- August 4th-7th!

Thursday, August 4th!

Friday, August 5th!

Saturday, August 6th!

Sunday, August 7th!

What time of day will you arrive? If you don't know yet, make sure you let us know when you set your travel plans!

What time of day will you depart? If you don't know yet, make sure you let us know when you set your travel plans!

REGISTRATION PAYMENT INFORMATION
We ask that everyone contribute a registration fee of $150. This helps us cover the cost of this conference, which includes acess to all events and every meal throughout the weekend.

This Grassroots Radio Conference and Radio Barnraising will feature a Pleistocene Hunter and Gatherer Subsistence Rate for` the four day weekend -- $75 total. This is a great rate for low-income folks, local volunteers, workshop presenters and anyone else with financial difficulties. Please consider paying this rate if you can afford it. All Grassroots Radio Barnraising attendees can join us for as little as zero dollars, but everyone who attends is encouraged to contribute what they can afford financially to the event.

(Dorm housing we have secured at Smith College is not included in registration, though limited free housing on-site and at homestays is.)

No one will be turned away for lack of funds, and if you need help with funds for transportation to the Grassroots Radio Conference and Barnraising, learn about the Solidarity Fund and how to apply here.

Please check or write the amount you can pay in the appropriate box.

Full Conference Cost ($150/weekend)

Day Rate ($60/days you are attending)

Local Rate ($50/weekend -- a great rate if you're planning to attend a few workshops, but eat and sleep at home!)

I need a scholarship, here's the total amount I can pay for registration (housing not included):

Please mail a check to Prometheus Radio Project, PO Box 42158, Philadelphia, PA 19101, tagged GRC or bring your check in August. Thanks!

WE'RE CONCERNED ABOUT YOUR DIET.
Please help us plan the conference menu!

I am an omnivore vegetarian vegan
(this information will help us plan food buys!)

Allergies or special needs?

HOUSING INFORMATION

NOTE: Housing is not included in registration! For the Northampton Grassroots Radio Conference and Radio Barnraising, you'll have the option of staying in a shared room at Smith College, in a comfy bed with accesible shower and bathroom, for $70/bed/weekend. The day rate for Smith beds is $30/day. Private rooms at Smith are not possible unless you pay for both beds in your room. You can also get a private room at any of the hotels listed from the main Grassroots Radio Conference and Radio Barnraising page.

At this late date, both homestays and dorms at Smith are limited. Consider making your own arrangements, or commuting to the conference if you live nearby!

For those who wish to stay on-site, there will be floor space available, for free, in a common space with toilet access (warning: this option requires that you bring your own sleeping bag and a shower and quiet environment are not guaranteed.) There are also homestays available in and around the Pioneer Valley area.

There is currently a homestay board, where you can potentially (not guaranteed) find a couch, bed, or floor in the area, or offer a couch/bed/floorspace if you have room, courtesy of SpaceShare! Fill out the information below and let us know your needs:

Please check the housing option you plan to pursue:

Smith College Dorms - Full Weekend $70

Smith College Dorms - Day Rate $30/day

  The Smith options only include one (1) bed of two (2) in each room,
  with showers and bathrooms down the hall. We will assign you a roommate.

  If you have specific needs from a roommate (ex. same
  identified gender) list them here and we'll do our   best to meet your needs. If you have already   discussed with a friend that you would like to   room with them at Smith, please enter their   name here:

On-site Crash Space
I will make my own hotel arrangements
I will my own homestay arrangements
Not Applicable, I live nearby

Do you live in the area, and can you offer housing? (If you can offer housing, post details on SpaceShare right away, or email libby.reinish@gmail.com.)

Yes

No

TRANSPORTATION

NOTE: transportation is not included in registration! For the Northampton Grassroots Radio Conference and Radio Barnraising, we can help you get a ride from the airport if you're coming in from out of town, and we can help you find a ride if other folks happen to be driving from your area, or passing you along the way! Soon, we'll be offering a rideshare board, where you can find a ride if you're a straggler, or offer a ride if you have an extra seat, courtesy of SpaceShare! Fill out the information below and we'll let you know when the rideshare board is ready!

I need a ride!
Select... Yes, from the airport! Yes, from my town to the Barnraising! Nope, I can get myself there.

I can offer a ride!
Select... Yes, I can do at least one airport shuttle run. Yes, I will be driving and can offer a ride from my area. No, I can't offer a ride.

OTHER NOTES AND THOUGHTS (optional)

What do you want to learn? Any thoughts on the Grassroots Radio Conference and Radio Barnraising in general?

Please provide some notes for us on what you are interested in learning at this upcoming event.

Do you have specific radio skills, engineering experience, or organizing strengths you want to share? Please share!

Do you have anything else you need to tell us? (Example: Let us know if you need childcare for your kids, if you have particular ways in which you'd like to volunteer, if you'd like to add some money onto your registration to support the Solidarity Fund, etc!)