CONFERENCE REGISTRATION FORM

Name _____________________________________________________________

Email ____________________________________________________________

Address____________________________________________________________

City State Zip _______________________________________________________

Telephone __________________

Please complete and return promptly. Mark the appropriate category and enclose a check, money order, or you can pay by credit card.

Credit Card: Name on card_________________________________________________________

CC# (Mastercard or Visa)________________________________ Expiration date__________________

3-digit # to right of signature line on back of card ____________________

Make checks payable to CSI

Friday, Saturday, & Banquet: Individual   $55 ___     Family of 2   $100 ___

Saturday only: $25___      Banquet only: $20 ___

Please check your meal preference: organic beef___    trout___    vegetarian___

Poster tables will be available in the Evergreen building atrium on the College of Southern Idaho campus
* Retail display:  $50              * Academic / non-profit displays:  No charge

Send registration form to:
Merry Waymire
College of Southern Idaho
PO Box 1238
Twin Falls, ID 83301

Phone (208) 732-6401
Fax (208) 736-2136