DEAF SENIORS OF AMERICA, INC.

OFFICIAL BIENNIAL CONFERENCE BID FORM

Date ______________________________________

  Name of Organization desiring to bid ________________________________________________________

  Non-profit Organization? c YES c NO        Tax ID Number (EIN) ____________________________

  Contact Person’s Name ________________________________________________________________

  Email address __________________________________________ VP # _________________________

  Address _____________________________________________________________________________

  City _______________________________ State _____________________ Zip ___________________

  Dates to host _________________________________________________________________________

  Conference Site (City & State) ___________________________________________________________

  Reasons for wanting to bid:       

  _______________________________________________________________________________________________

  ____________________________________________________________________________________

  ____________________________________________________________________________________

  Name of Hotel Headquarters: ____________________________________________________________

c Attach letters from local organizations supporting your desire to bid.

c Attach a letter from your hotel or conference center with guarantees on general services, prices, services for disabilities, etc.

c A deposit of $2,000 check payable to ‘DSA’ and mail to:

       Jim Potter, 15139 West Woodbridge Drive, Surprise, Arizona 85374

c I have read and understand the Overview of Conference Host Site Requirements and Host Responsibilities as outlined under Item #9 and #10 in this Conference Handbook.

______________________________________                                 Signature/Title