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ChLA 2009 Registration Form Final


									                            The Best of Three
                            ChLA Conference – June 11-14, 2009
                            Registration Form
                         After March 25th, you may register online at
 Name ________________________________________________ First Time ChLA Attendee? Yes                              No

 Institution __________________________________________________________________________________

 Street Address ______________________________________________________________________________

 City ____________________________ State_______ Postal/Zip Code ___________ Country _______________

  Conference registration includes continental breakfast
Full Conference Registration                                     Registration form must be accompanied by payment
                                                                 in U.S. funds only. Make checks payable to the
►$150/ChLA Member          _________________                     Children’s Literature Association. Registrations paid
                                                                 by credit card may be faxed to the ChLA office at
►$190/Non-Member             ________________                    (269) 965-3568 or submitted online.

►$75/Full-Time Student* ________________
                                                                  *Full-time students must include a copy of current
                                                                    student ID or another form of student status
Daily Registration: Circle Day(s)
                                                                             verification with registration.
     Thursday          Friday            Saturday                If you are registering after May 22, 2009,
     June 11         June 12              June 13                please register online or fax.
                                                                 After May 29th, please register onsite.
►ChLA Member          $60 x ______ day(s) __________
                                                                 Credit Card used:      Mastercard      Visa
►Non-Member           $75 x ______ day(s) __________
                                                                 Card # ____________________________________
►Full-Time Student* $40 x ______ day(s) __________
                                                                 Exp. Date __________________________________
Awards Banquet - Saturday, June 13 _____________                 Name as it appears on card:
     (not included in registration fee)                          __________________________________________
►$35 per person
      (circle ONE entrée selection per person)                   Signature __________________________________
   Lemon-Rosemary Chicken with Rosemary Butter                   Mail to: Children’s Literature Association
                                                                           P.O. Box 138
   Grilled Atlantic Salmon with Bouillabaisse Sauce                        Battle Creek MI 49016-0138

   Sweet Potato and Pecan Ravioli with Ginger Butter               *For special assistance contact the ChLA office at
Late Registration Fee - After May 1st
                        (add $20)______________

Total Amount Enclosed         __________________

         Cancellations will be accepted in writing prior to May 29, 2009. No refunds will be issued after May 29, 2009.
                             A $35 administration fee will be assessed on registration refunds issued.

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