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The Best of Three ChLA Conference – June 11-14, 2009 Registration Form After March 25th, you may register online at www.childlitassn.org Name ________________________________________________ First Time ChLA Attendee? Yes No Institution __________________________________________________________________________________ Street Address ______________________________________________________________________________ City ____________________________ State_______ Postal/Zip Code ___________ Country _______________ Conference registration includes continental breakfast Payment 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 firstname.lastname@example.org 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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