Registration Form

Please read the Cymdeithas Madog Fitness Policy.


Will your registration fee will by paid along with someone else's (spouse, society, etc.)? *
 no
 yes
If you are part of a group paying together, list the name of the person in charge and their email address and/or phone number.
First Name : *
Last name : *
Street address or P.O. box : *
City : *
State or Province : *
Zip Code or Postal Code : *
Country : *
Email address for emails from Cwrs Cymraeg (or "none") :
Primary phone : *
Other phone :
Name as you want it to appear on name tag and roster : *
Select residence type (all singles) : *
All rooms are single en suite rooms (bathroom with shower for each room). If there is someone you wish to room near, please give us their name (or "none"). *
Do you smoke? *
Participants will need to walk to the dining hall building, about 3 blocks from the Conference Centre. Describe any special needs or requirements you may have (or write "none"). *
Please list any special dietary needs or restrictions (e.g., diabetic, vegetarian, etc), or write "none". *
Next of kin or other person to be contacted in the event of an emergency (July 25 - August 1, 2010) : *
Relationship to you (daughter, friend, etc.) :
Contact person's address JULY 25 - AUGUST 1, 2010 :
Primary phone number (with country code if not the United Kingdom, Canada, or the US) :
Other phone number (with country code if not the United Kingdom, Canada, or the US) :
Primary email address of the contact person July 25 - August 1, 2010 :
Alternate email address of the contact person :
Please give any additional information that may help us contact or work with this person. Please let us know the name(s) of anyone else at this phone number that we may talk to. If you have someone in or near Cardiff, please give their phone/email here.
Allergies and medications *
 I have no allergies or medications that Cymdeithas Madog would need to know about in case of an emergency.
 I will mail the Registrar a list of my allergies and medications.
 I will provide a list of my allergies and medications at check-in.
 I am listing my allergies and medications below.
List allergies (and severity), medications (dosages), medical conditions.
Select "yes" to indicate you have read and understood the Cymdeithas Madog Fitness Policy and are physically fit to participate in the cwrs. *
If you have attended Cwrs Cymraeg before, please list your three most recent levels :
If you have not attended Cwrs Cymraeg before, are you a complete beginner?
If you have not attended Cwrs Cymraeg before and have some knowledge of Welsh, please write a short paragraph in Welsh telling us a little bit about yourself and/or how you came to be interested in Welsh.
Additional information about your Welsh language background that you would like to share with us (such as previous Welsh instruction apart from Cwrs Cymraeg Cymdeithas Madog, such as extensive residence in a Welsh-speaking community in Wales, etc.)
Questions, concerns, comments about CURRICULUM :
Questions, concerns, explanations, comments (NOT about Curriculum or placement) :
ARRIVAL: Closer to the time of the Cwrs you will be asked for specifics about your transportation to and from the cwrs. For now, please describe how you may arrive (air, train, etc.) and when.
The National Eisteddfod will be held on the old steel site, Glyn Ebwy, Blaenau Gwent, not far from Cardiff for the week immediately after the Cwrs. Please discuss your plans and expectations if you are interested in attending.
Receipt for donation - Please give name(s) and addresses(s) for acknowledgment of gifts is "in honor of" or "in memory of" and the name of the person or group. Also, give the name and address of the person to whom a receipt should be sent.
Receipt for tuition and fees - If you require a receipt to get reimbursed for tuition and fees (by an employer, business, or organization), please give the name and address of the contact person below. Your receipt will be given to you at the Cwrs itself.
Please describe any activities, events, and sites of interest to you in the Cardiff area. We would like to share ideas with other registered participants, especially those who have not been to South Wales before.
 

FITNESS POLICY

Please read the following carefully:

Cymdeithas Madog will do what they can to accommodate the physical limitations of course participants, but we can assume no responsibility in the event that we are unable to do so. Participants must assume the responsibility for determining whether they are physically and medically able to participate. Participants must also assume responsibility for medical conditions that could result in medical emergencies while they are at the course.

Deposit

Send your check/cheque/money order for £100 made out to Cwrs Cymru Deg 2010 to:

Shirley McKee, Registrar
Cwrs Cymru Deg
3033 Willowbrook Way
Beavercreek  OH  45431-7702 USA

Contact a bank to pay in POUNDS STERLING, £, (Great Britain Pounds, GBP).  Alternatively, you may pay your deposit online.  A place will not be reserved for you Cwrs Cymru Deg 2010 until the Registrar has received your deposit.

Email

Discussion Group

The Cwrs Cymraeg Discussion Group (hosted by Google) is for this year's registered learners only.  As information becomes available, pages will be added about such things as:

  • Curriculum placement
  • Travel arrangements
  • What to bring
  • Local conditions
  • Invoices

Cwrs participants are welcome to discuss matters related to the Cwrs.