Click on logo for directions to Conference Center Vicki Holman, Registrar

No On-Site Registration Registration Deadline: November 10, 2011 Today's Date: _________________________ Asilomar Reading Conference Jan. 13-15, 2012 “Byte into E-Literacy” Registration Form Day Only 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: All registrants now have a choice of joining 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 Check Day (s) Attending Meals/Fees Prices _____ regular meals _____ Friday Friday Dinner $24.50 ________ _____ vegetarian meals _____ Saturday Saturday Breakfast $12 ________ _____ other (explain needs) _____ Sunday Saturday Lunch $15 ________ __________________________   Saturday Dinner $24.50 ________ __________________________   Sunday Breakfast $12 ________ __________________________   Sunday Lunch $15 ________ _____ Sunday Dining Room       _____ Sunday Box Lunch   *Meal Order Total: $_____________             SCCRC or SCRA Member $75.00 ________     Registration ($75)+SCCRC/CRA Membership ($40) $115.00 _______     Registration ($75)+SCRA/CRA Membership($40) $115.00__________     Registration($75) + SCCRC, SCRA, and CRA Membership($80) $155.00___________     Non-Member/Guest $115.00 _______     *Meal Order Total (from above) $_____________     Asilomar Day Use - NOT OPTIONAL - $30 ___ $30.00___     Late Fee after Nov. 10, 2010 ($10) $10.00 ________             TOTAL FEE $ ___________

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