Asilomar Overnight Registration (unsecured on-line version)

Santa Clara County Reading Council

Asilomar Overnight Registration (unsecured on-line version)

Deadline for Registration: November 10, 2011

Instructions: Complete all information; incomplete forms will delay registration. ONE FORM PER 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, 2011.

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.

Today's Date
First Name
Last Name
Female/Male
Mailing Address
City
State Zip___+___
(Area) Home Phone
(Area) Work Phone
Home E-Mail
School
District
Position
Grade Level/Other
SCCRC Membership
Type of Payment
Credit Card
Credit Card #
Expiration(Mo/Day/Year)
Name on Card
Meal Order
If other, explain
Sunday
Accomodation Plan (SEE BELOW)
Confirmed Roommates
*Handicapped (Explain Needs)
Registration Fee
Lodging Fee
Late Fee after 11/10/11 ($10)
Total Fee
Questions/Comments

Contact Vicki Holman if confirmation of registration form has not been made within 72 hours.

Vicki Holman, Registrar

Overnight Rates per person: 2 nights lodging + 6 meals (All rooms are non-smoking.)

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

If sending payments by checks or purchase orders, please make payments to: SCCRC-AC and mail to:

Vicki Holman, Registrar
315 Wildflower Park Ln.
Mountain View, CA 94043

Other information or questions please call Vicki Holman, Registrar, at 650-428-0936 or click on the link above to e-mail.

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