Registration Form
Registration Form A. Conference Rates (check one): __ $90. Friday and Saturday. __ $60. Friday only. __ $30. Saturday only. __ $20. Student. Fri. and Sat. (scholarships available) B. Meals and Lodging Rates (Check one, as applicable): __ $50. 3 meals and overnight. __ $25. 3 meals only. __ $15. Friday dinner only. C. Spouse and Partner Rates (Check one, if applicable): __ $50. 3 meals and overnight. __ $25. 3 meals only. __ $15. Friday dinner only. D. Add A, B and C: $__________ Please mail check made payable to AAPC NW with this form to: Ronald Kirstein 1834 North 183rd Street Shoreline, WA 98133-4610 Name(s) for name tag(s): ___________________________________ Address (change only): _____________________________________ ________________________________________________________ E-Mail: __________________________________________________ Phone: _________________________________________________ Special Diet: _____________________________________________ Special Accommodations: ___________________________________
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