SEMINAR REGISTRATION
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REGISTRATION FORM

       Session:                   Price:     

       Wednesday, May 14

____ Member                     $25.00

____ Non-Member               $50.00

____ Student  member        $10.00

 

       Thursday, May 15

____ Member                     $25.00

____ Non-Member               $50.00

____ Student                      $10.00

 

       Full Registration

____ Member                     $50.00

____ Non-Member               $100.00

____ Student                      $20.00

 

Registration Deadline 5/25/2004 $10.00 late fee after deadline

Name:                                                              

Address:                                                          
                                                                       
                                                                       

Phone or fax:                                                    

Method of payment:

____ Check enclosed

____ On-site payment

ASCLS member number:                                   

Mail completed registration form and payment to:

Susan Radley, ASCLS-AND           
P.O. Box 9413                                
Scottsdale, AZ                        85252                                                          

                                                      

CIRCLE THE SESSIONS YOU WISH TO ATTEND  A, B, C, D ,E ,F ,G ,H, J, K, M, N, P, R, S,                                  

ASCLS-AND Member Meeting:            Price           

Tuesday June 1, 2004       Member:       Free
        Nonmember $10.00
 5:00 pm      I plan to Attend  __Yes    __No

 

 
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