Annual Conference
2007 Registration Form

 

Name

____________________________________________

Address

____________________________________________

City/State/Zip

____________________________________________

Phone

____________________

 

 

 

By Nov 25

After Nov 25

_____ Parent

 

$50

$60

_____ Student

__________________________________
School

$20

$30

_____ Educator

__________________________________
School District/Position

$65

$75

_____ Other

__________________________________
Organization

$65

$75

Payment Information

_____ Check

 

 

_____ Money Order

 

 

_____ Purchase Order

# ___________________

 

_____ Credit Card

#_________________________ Exp. _______

 

 

Send payment with registration form to:

West Michigan Inclusion Network

PO BOX 7

Byron Center, MI  49315

To Fax Registration Please Call 616 889 3808

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