ATRI Conference Registration Form

2008 ATRI Conference Registration Form

Name
Organization/Business
Street Address
Street Address (cont.)
City
State
Zip
E-mail address
Telephone (day)
Telephone (evening)

In order to qualify for the group rate, you must provide the names of each member of your group:

_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

Enclosed is my check payable to: Center for Adult Education
Please charge the registration fee to my:
- Visa
- Master Card
- Discover Card

Card No.
Expiration Date
Name as it appears on card
Card Holder Signature

Please fill out, print, and return to:

Center for Adult and Continuing Education
Misericordia University,
301 Lake Street,
Dallas, PA 18612