WWU Children's Literature Conference

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                                                   WWU Children’s Literature Conference
                                                                Saturday, March 6, 2010
                                         Please make a copy of this form and fill out separately for each participant
  Required Information
  Name: (Last)      please print         (First)               (MI)     WWU #(if known):

  Day Phone                        Date of Birth:                       E-mail:       please print legibly

  Mailing Address      Home /       Work:                               City:                   State:       Zip:

  School/Work Affiliation:

                                                                             Early Rate              Late Rate
                                                                            Payment BY            Payment AFTER           Amount
 √                 Registration fee includes lunch                            2/12/10                 2/12/10
         Conference Registration                                 $90               $115
         Retired Teacher                                         $45               $ 75
         Full-Time College Student or WWU Faculty                $40               $ 75
         I would like to make a CL Conference student scholarship donation in the amount of                           $
         Student Volunteer                                               $20

                                                                                               Total Due
                                   Clock Hours will be available on-site at the conference.
 ► Dietary Accommodation:  Vegetarian  Other:
  CANCELLATION / NO SHOWS: No refunds for registrations. This policy applies to all registrations,
  including those forms accompanied by an institutional purchase order.

  ______________________________________________________________                                    _________________
  Signature                                                                                          Date

   ▼Payment Methods (U.S. Fund Only)▼ Payment must be submitted with registration.

  Institutional PO#________________________ Mail to WWU ► WWU – EESP, MS-5293                   FOR OFFICE USE ONLY
                                                                 516 High Street
  Check/Money Order – Payable to WWU / Mail to WWU ►             Bellingham, WA 98225          Workshop: FXCON CSHCDR

  Visa        MasterCard ► Payment Secure Fax # (360) 788-0854

Card Number: _____________________________________________________________

Card Holder Name: ______________________________Expires (MO/YR): ___________

Card Holder Signature: ______________________________________________________

     Credit Card Payments Only May Be Sent to the Secure Fax WWU-EESP Cashier, (360) 788-0854
      For registration/payment information:                                       For program/curricular information:
      e-mail: eesp.registration@wwu.edu                                               Bond Literature Conference
      Phone: (360) 650-3308                                                             http://www.wwuclc.com
      Secure Fax: (360) 788-0854