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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