Click on logo for directions to conference center. Vicki Holman, Registrar

Santa Clara County Reading Council’s Asilomar Reading Conference Jan. 13-15, 2011 “Byte into E-Literacy” Registration Form Overnight Registration Deadline for Registration: November 10   Today’s Date ________________________ Instructions:  Complete all information; incomplete forms will delay registration.  One form per participant.  Assignments are made only when registration and full payment are received from the participant.  Adults only, please.  Mail early to ensure your registration.  Registration will be accepted on a space-available basis. Sorry, no refunds; registration may be transferred.  Please notify registrar of any changes immediately.  Late fee ($10) after November 10. Please print clearly!  Print your name as you wish it to appear on your name badge.  Please Note:  Registrants may now choose to become a member of the Santa Clara County Reading Council (SCCRC), the Santa Cruz Reading Association (SCRA), or both. Name __________________________________________________________F______M_____                                       Last                                                   First                                                     Initial Mailing Address ____________________________City _______________________State_____ Zip __________  Phone (_____)____________________________ Home E-Mail ___________________________________ District _________________________________ School ________________________________________  Position ________________________________ Grade Level ______ Other ______________________ SCCRC Membership                 (     ) new     (     ) renewal Meal Order: Please mark selections (x): ( ) Sunday Dining Room or ( ) Sunday Box Lunch ( ) regular meals ( ) vegetarian meals ( ) other (explain needs) __________________________ Overnight Rates per person: 2 nights lodging + 6 meals (All rooms are non-smoking.) Accomodation Plan (circle one): A1 A2 B1 B2 C2  *Lodging Total: __________ Rates: per person Plan A (1 to a room) Plan B (2 to a room) Plan C (3 or more) # 1 Historic Rooms: $340.00 $250.00 N/A #2 Standard Rooms $425.00 $270.00 $230.00 List confirmed roommates only: 1. ________________________________ 2. ________________________________  3. ________________________________ *Handicapped (explain needs) _____________________________________________ Registration Fees with Lodging       SCCRC or SCRA Member Registration Fee Only $75 $ 75________   Non-member/Guest $115.00 $ 115_______   Registration ($75)+SCCRC/CRA Membership ($40) = $115 $ 115_______   Registration ($75)+SCRA/CRA Membership Fee ($40)  $115________   Registration($75) + SCCRC, SCRA, and CRA Membership ($80) $155_________   * Lodging Total (from above) $ __________   Late fee after Nov. 10, 2011-$10.00 $ __________   TOTAL FEE: $ __________

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