|
| Click on logo for directions to conference center. |
|
Kathy Noether, Registrar
|
Deadline for Registration: November 10, 2009
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. No on-site registration. Sorry, no refunds;
registration may be transferred. Please notify registrar of any changes. Late fee ($10.00) after November 10, 2009.
Please print clearly! Print your name as you wish it to appear on your name badge.
Name ____________________________________________________ F___ M ___
Mailing Address_____________________________________________________________
City____________________________________ State _____ Zip ______+______
Home Phone_____________________ Work Phone _________________________
E-Mail______________________________________________________________
District ____________________________School ___________________________
Position ____________________________ Grade Level ______ Other __________
SCCRC Membership ______ new ______ renewal
( ) Check (payment in full to SCCRC-AC)
( ) Purchase order enclosed (NO requisition). Must have copy of PO, not just number.
( ) Credit Card. We accept VISA, Mastercard, Discover, American Express
CREDIT CARD #______________________________________Exp Date _______
Name on card__________________________Signature______________________
Mail to: SCCRC Asilomar Conference Registrar:
Kathy Noether, 4246 Meg Drive, San Jose, CA 95136
Other information or questions, please call Kathy Noether, registrar
H: 408-267-3426 F: 408-448-0447 E: knoether@aol.com
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:
|
$335.00
|
$240.00
|
N/A
|
|
#2 Standard Rooms
|
$420.00
|
|
$225.00
|
List confirmed roommates only: 1. __________________ 2. __________________
3. ____________________
*Handicapped (explain needs) _____________________________________________
|
Registration Fees with Lodging
|
|
|
| |
SCCRC Member $75
|
$ __________
|
| |
Non-member/Guest $115.00
|
$ __________
|
| |
Registration ($75)+SCCRC/CRA Membership ($40) = $115
|
$ __________
|
| |
* Lodging Total (from above)
|
$ __________
|
| |
Late fee after Nov. 10, 2009-$10.00
|
$ __________
|
| |
TOTAL FEE:
|
$ __________
|
|
