Chaperone Online Registration Form — UW Oshkosh Department of Music

PERSONAL INFORMATION

First Name (Required)

Middle Name (Required)

Last Name (Required)

E-mail (Required)

MAILING ADDRESS

Street Address (Required)

City (Required)

State (Required)

Zip/Postal Code (Required)

HOUSING

Do you plan to stay overnight in Gruenhagen Conference Center? (Required)

Yes
No

Gender (Required)

Male
Female

Will you need to park a car on campus? (Required)

Yes
No

Do you have any special meal requirements?

Vegetarian
Vegan
Kosher
Diabetic

Other meal requirements?

CHAPERONE REGISTRATION OPTIONS

OPTION 1: On-Campus Overnight Guest-Single Occupancy with Meals

I will be accompanying a student and wish to stay in a single room at Gruenhagen Conference Center. I will be joining the participants for meals.

$30.00 -- Two-Day Meal Ticket (This fee includes one dinner, one lunch, and appetizers)

$44.00 -- Single-occupancy for Gruenhagen Conference Center (Fee includes breakfast)

$74.00 -- TOTAL to be mailed (Check or Money Order Only - No Cash)

OPTION 2: On-Campus Overnight Guest-Single Occupancy - No Meals

I will be accompanying a student and wish to stay in a single room at Gruenhagen Conference Center. I will not be joining participants for meals.

$44.00 -- Single-occupancy for Gruenhagen Conference Center (Fee includes breakfast)

$44.00 -- TOTAL to be mailed (Check or Money Order Only -- No Cash)

OPTION 3: On-Campus Overnight Guest-Double Occupancy with Meals

I will be accompanying a student and wish to share a double room at Gruenhagen Conference Center. I will be joining the participants for meals.

$30.00 -- Two-Day Meal Ticket (this fee includes one dinner, one lunch, and appetizers.)

$27.00 -- Double-occupancy for Gruenhagen Conference Center (Fee includes breakfast)

$57.00 -- TOTAL to be mailed (Check or Money Order Only -- No Cash)

I wish to request a roommate

please indicate their first and last name

Roomate Selection

My requested roommate is attending as a Participant
My requested roommate is attending as a Chaperone
I do not wish to request a roommate. Please assign a roomate.

OPTION 4: On-Campus Overnight Guest-Double Occupancy - No Meals

I will be accompanying a student and wish to share a double room at Gruenhagen Conference Center. I will not be joining the participants for meals.

$27.00 -- Double-occupancy for Gruenhagen Conference Center (Fee includes breakfast)

$27.00 -- TOTAL to be mailed (Check or Money Order Only -- No Cash)

I wish to request a roommate

please indicate their first and last name

Roommate Selection

My requested roommate is attending as a Participant
My requested roommate is attending as a Chaperone
I do not wish to request a roommate. Please assign a roommate.

PAYMENT

Please mail check or money order to:

Department of Music/Attn: Music in Motion
University of Wisconsin Oshkosh
800 Algoma Blvd.
Oshkosh, WI 54901

Please make check payable to "UWO Music/Music in Motion"