IWL 2011 Conference Registration Form

Name________________________________________________________________________

Full address___________________________________________________________________

Phone_____________________Email___________________Chapter_____________________

I will bring items for sale in the bookstore  Yes___No___     I require vegetarian meals Yes___No___

Please check desired services listed below and total the amounts of your selections.

                                                                                                                Member                                 Nonmember

Full conference mailed by 25 August 2011                $100____                    $120____

Full conference mailed after 25 August or at door     $115____                    $135____

Friday only (includes lunch)                                      $  60____                    $  70____

Saturday only (includes lunch and banquet)               $  80____                    $  90____

Half day with no meals                                             $  30____

Each extra banquet ticket(s)                                     $  25____

Complete and send with payment to LaDean Messenger, 829 Callie Street, Chubbuck, ID 83202