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Conference Registration Form

Red = Required Field

Your Name:
Your Title:
Institution:
Address:
City:
State:
ZIP:
Phone:
Your Email:
Are you a member?	Yes \| No
Which Conference/Event are you attending?
Registration Details: Registration Fee: Full conference for members $70.00 Full Conference for non-members $80.00 Late Fee: Register after 4/02/11 – pay full fee plus $15.00 Per Day rate: Tuesday- member $50.00 non-member $55.00 Wednesday-member $30.00 non-member $35.00 (All registration fees include meals for that days’ events) Registered guest for Tuesday evening banquet $25.00
Please indicate your attendance:
Guest Name:
Dinner Choice for Tuesday evening banquet: Country style pork ribs New York Steak (flame grilled 12 oz. New York Steak) Mushroom Chicken (flame grilled chicken breasts in mushroom sauce
Special dietary needs:
Please note: Breakfast is included with the room. If you are not staying in the hotel you will need to make separate breakfast arrangements. Registration Deadline is April 04, 2011. Submit this registration and mail your payment to: WyASFAA Adrienne Plemel, WyASFAA Treasurer Western Wyoming Community College PO Box 428 Rock Springs, WY 82902
Note: A separate registration is needed for each person attending the conference but one check per institution is permitted. Please indicate the name of each attendee the check covers. Hotel information: C’mon Inn of Casper 301 E. Lathrop Rd Casper, WY 82636 http://www.cmoninn.com/midwest-hotel-locations/casper/ Registration: 1-866-782-2690 Let the receptionist know you are attending the WyASFAA conference to get the lower rate. Room Rates: $89.99 for a single or double
Payment:
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