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Registration Form
CHARTA
Fall Conference
Home
| Conference | Fall
Conf Info | Directions
Date:
Monday, October 21, 2002
Time: 7:45am to 4:15pm
(print
out this form and complete)
Name:
_______________________ Organization: ________________________
Home
Address: _________________________________ City _______________
State
_____ Zip ________
Telephone:
(H) ___________________ (W) _____________________
FAX
_______________________
E-Mail
_____________________________
Type
of Participant Fee (please circle choice)
| Current
Charta Member |
$25.00 |
($30 after 10/16) |
Joining
Member
(not previously a member in 2002)
|
$45.00 |
($50 after 10/16) |
| Current
Charta Student Member |
$8.00 |
($13 after 10/16) |
Joining
Student Member
|
$13.00 |
($18 after 10/16) |
| CEU |
$10.00 |
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Total
Fees Enclosed $ ______
Charta's
EIN - 52-1690908
Make check payable to Charta.
Complete this form and return it with payment by October 16,
2002 to:
CHARTA c/o Joan Joyce
3811 Albemarle Street
Arlingotn, VA 22207
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