Name:______________________________________________________________________ Title or Occupation: ____________________________________________________________ Organization: _________________________________________________________________ Home Address:________________________________________________________________ Work Address:________________________________________________________________ Phone: (h)_______________ (w)__________________ Email:___________________________ |
Please print out and send completed form and check (payable to EEASC ) for all fees to:
Dr. Sharon Miller Please send a separate form for each person registering, but rooming together and mail together if possible. |
| Entire Conference (Fri -
Sun) __$40 (member) __ $50 (non-member) One Day only __ $20 ($25 non-member) Registration includes all conference activities. No registration fee for spouse and /or children not attending sessions/workshops/field trips. |
$ _____________ | Special Needs Here: |
| EEASC MEMBERSHIP EEASC __ 1 year new or renewal |
$ _____________ | Membership Categories: Active $20, Student $10, Contributing $25, Sustaining $40, Corporate $100 (circle one) |
| LODGING at Camp St. Christopher
2 double beds per room $69/night for 1 or 2, $5/Person more/night for extra persons. Indicate your plans by filling in the appropriate amount on the line(s): |
|
Meals Adult: $8 breakfast, $10 lunch, $15 supper
|
| Grand total (including registration fee, meals and lodging) | $ _____________ | |
| TOTAL ENCLOSED | $ _____________ | |
Please send completed form and check
(payable to EEASC) for all
fees to: |
||
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