Medical Office Registration Form s2

HAWTHORNE IN THE BERKSHIRES, JUNE 12-15, 2014 REGISTRATION FORM (Please Print) Sponsored by the Nathaniel Hawthorne Society & Hosted by Massachusetts College of Liberal Arts, 375 Church Street, North Adams, MA 01247 CONFERENCE ATTENDEE INFORMATION Attendee Name:  Male Academic Affiliation, if any:  Female Street Address: Best Phone Number. ( ) City: ST: Zip Code: Country: Email:

Will you arrive via public transportation? If yes, via which nearby town? (If known)

*Hourly shuttles run from Pittsfield and Williamstown to North Adams except on Sundays, when we will use our own shuttles to return you to either town. CONFERENCE REGISTRATION AND FEES CONFERENCE REGISTRATION includes reception and lunches on Friday and Saturday:------$160 SATURDAY EVENING BANQUET (OPTIONAL): PER PERSON COST ------$40 Campus housing in newly-renovated Hoosac Hall (with clean, spacious hall baths) includes linens, all breakfasts and Friday dinner in campus dining hall: Single Room: (covers all 3 nights) ------$265 Shared Room: (covers all 3 nights) ------$175 Do you have a roommate preference? Name of preferred roommate:

 Yes ______

Please assign me.  No  Spouse or other guest to share room (add $175): Name of Guest:

 Yes

 No $175 Be sure to include all costs (guests, roommate or single room), and include the Saturday evening banquet cost, if attending. REGISTRATION & BANQUET FEE SUB TOTAL

A limited number of rooms have been reserved at the Holiday Inn in downtown North Adams for $144/night plus taxes and fees. www.holidayinn.com/bershiresma Group Code: NHS Or call: 413-663-6500. The hotel is about 1 mile from campus.

AVAILABLE SIDE EXCURSIONS Optional side excursions (pre-registration guarantees your seat on the shuttle, and ticket at the group rate; latecomers may be accommodated if space is available but at the NON-DISCOUNTED rate.) Saturday afternoon (CHOOSE ONLY ONE) 1. Berkshire Athenaeum and Arrowhead, historic home of Herman Melville and the Berkshire Historical Society: $23/person 2. Shuttle van to Natural Bridge and Mount Greylock: ------$10/person 3. Hancock Shaker Village in Stockbridge: ------$28/person 4. Free walking tour of North Adams: Check here if interested: ______NO. in PARTY: ______------FREE Sunday morning: (CHOOSE ONLY ONE) 1. Hancock Shaker Village in Stockbridge ------$28/person 2. Free walking tour of North Adams: Check here if interested: ______NO. in PARTY: ______------FREE 3. Other suggestions, based on shuttle availability: SIDE EXCURSION SUB TOTAL Page 1 of 2

HAWTHORNE MEMBERSHIP Please renew my Hawthorne Society Membership* Standard Membership ------$25 Student Membership ------$5 Life Membership ------$250 *Students and transitioning scholars may be subject to a housing rebate, depending on availability. Check here if you wish to be included in this consideration. ______YES, I would like to receive student housing consideration.

HAWTHORNE SOCIETY MEMBERSHIP TOTAL (Conference registration, campus housing, banquet, and any excursion you will be attending, and Hawthorne Society Membership, if applicable. Also Include cost for any guest attending.) GRAND TOTAL Mail* this form and check to: Rosemary Fisk English Dept. Samford University Birmingham, AL 35229

*Online registration and payment through PayPal soon will be available on the Hawthorne Society website at http://www.tamiu.edu/hawthorne/