PERSONAL INFORMATION:
Name as it should appear on name badge:
(please do not use special accents, i.e. umlauts etc.)

First:  
Last: 

Affiliation: 

Mailing Address:
Line 1: 
Line 2: 
Line 3: 
Line 4: 
Line 5: 

Day Phone:  
Fax: 
Email: 



REGISTRATION FEE FOR PARTICIPANT:

Registration Fee: -- $40



SOCIAL ACTIVITIES
WORKSHOP DINNER 8/24

Do you plan to attend the workshop dinner on Wednesday, Aug. 24?  Yes  No
(registration fee covers the workshop dinner cost for the participant only, cost for accompanying adults is $30 each)
Select one of:  Prime Rib  Filet of Salmon with Sesame Teriyaki sauce  Grilled Vegetables with Spinach Cannelloni

Additional Dinner Tickets (not including participant): (please indicate number for each type of meal below)
 Prime Rib;  Filet of Salmon with Sesame Teriyaki sauce;  Grilled Vegtables with Spinach Cannelloni




 TOTAL: 

Registration Fee: $40 (includes dinner for participant only)
Cost of Additional Dinner Tickets ($30 per guest): $ 
Total: $ 
(Payable by checks or by cash at the workshop reception)