Registration Form
|
| Name: |
______________________________________________
(Last)(First)(Initial(s))
|
| Title: |
__________________________________ |
| Badge to read: |
__________________________________ |
| Address: |
______________________________________________ |
| |
______________________________________________ |
| City: |
| _____________________ |
Postal Code:______________ |
|
| Tel: |
| _____________________ |
Fax:______________ |
|
| E-mail |
_____________________ |
| Registration Fee* |
 |
Regular |
$70 |
 |
Student |
$50 |
 |
Guest |
$30 wine & cheese and banquet |
|
| *Registration fee includes the wine & cheese, lunch, coffee breaks, and banquet |