2008
REGISTRATION FORM
CONTACT INFORMATION
Name: __________________________________________________________________
Address: ________________________________________________________________
Business or Daytime Phone:
_______________________________________________
Email Address: ___________________________________________________________
Are you a member of WVAS for
2008?
____ Yes ____
No
Session chairs and poster/paper judges are needed (non-students only)!
Are you willing to chair a
session?
____ Yes ____ No
Are you willing to serve as a
judge?
____ Yes
____ No
Preferred discipline _________________________________________
Registration Fee
Member
____ Early (postmarked by March 15): $15 ____
Late: $20
Nonmember
____ Early (postmarked by March 15): $20 ____ Late: $25
Student
____ Early (postmarked by March 15): $ 5 ____
Late: $10
Membership Dues
____ Regular: $25.00 ____ Student: $10.00
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Total enclosed (please calculate the total)................................$
*Please submit a completed copy of this form and include fees as a check payable to WVAS and mail to the address below.
Mark Flood
BCG
Department