2021 NWCCC Conference Registration $60

First Name (required)

Last Name (required)

Your Email (required)

Phone

Street Address

City

State

Zip Code

Are you attending in person?
YesNo

If you are attending in person, please answer the following questions:
Are you fully vaccinated for COVID-19?
YesNo
If so, what was the date of your most recent injection?

On Saturday, November 13, I will only attend the in person conference if I can answer “No” to the following information:
o Have you been in contact with a person who has tested positive or is in the process of being tested for COVID-19?
o Have you or anyone you’ve been in contact with traveled outside of the United States recently? And if so, have you been quarantined in accordance with public health guidelines?
o Has a medical professional told you to self-quarantine?
o Are you having trouble breathing, or have you had flu-like symptoms within the past 48 hours (e.g., fever, cough, shortness of breath, sore throat, runny nose, body aches, chills or fatigue)?

Camera Club Affiliation
Camera club(s) you belong to or regularly attend (in person or online):
Other/NoneBainbridge Island Photo ClubBellingham Photography ClubEastside Camera ClubF::67 Camera ClubKirkland Photo ClubKEGS Digital Imaging SIGKitsap Photography GuildMt. Baker Camera ClubOlympia Camera ClubOlympic Peaks Camera ClubPilchuck Camera ClubPrintmakers CritiquePuget Sound Camera ClubRainier Hills Photography ClubSeattle Photographic SocietySeattle Mountaineers PhotographySkagit Valley Camera ClubSound Exposure Photo ClubTacoma Photographic Society