NAME_______________________________________________________________

        ADDRESS___________________________________________________________

        STATE & ZIP_____________________________PHONE____________________

        Email ADDRESS_____________________________________________________

        ORGANIZATION_____________________________________________________

___ I am a family member/friend of a Silent Witness

I would like to speak at the

____ Saturday AM breakfast   ___Saturday afternoon rally&march   ___Sunday conference

___I have included photos of my state’s Silent Witness project for use in promotional materials.  Please return them to me when finished.

___I will attend the Saturday breakfast event, Saturday march & Sunday conference      ($60.00)

___I will attend the Saturday march & Sunday conference ($35.00)

___I will attend the Saturday breakfast event & Saturday march ($25.00)

___I will attend the Saturday march only – no fee required.

___My check is enclosed, made payable to Silent Witness National March,

 in the amount of $________.

Saturday breakfast event includes:  buffet breakfast at Westin Hotel, slide show presentation of Silent Witness event, music, international speakers & awards ceremony. ($25.00 per person).

Sunday Best Practices Conference includes: buffet breakfast at Westin Hotel, opening welcome from Janet Hagberg, Silent Witness Executive Director, 6 groups presenting their best practices programs from around the world, printed materials on programs, information from various state Silent Witness projects & awards presentation.

($35.00 per person).

I will be bringing _____ Silent Witness figures from the state/country of _________ for the

March on Saturday afternoon.

For more information about the March to End the Silence and Best Practices Conference, please contact Nancy Rafi at (401)847-2798 or by email at nrafi@hotmail.com

Your payment for each event is your confirmation of attendance.  Please note that both Saturday morning breakfast event and Sunday conference have limited space and will be confirmed on a first come, first served basis.

Please send Registration Form & check payable to Silent Witness National March, to:

The Second National March to End the Silence, 22 Calvert Street, Newport, RI USA 02840

Home Page	General Information	Agenda of Events	“Best Practices” Submission Form
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