2004 AVLN Conference Registration Form

2004 AVLN Conference Registration

If you have any questions, please contact Bob Paulson, bpaulson@puc.edu or Melvin Northrup, mnorthrup1@yahoo.com.

* Enter information as you would like it on your name tag.
*Full Name:
*Title:
Place of Employment:
*Grade Level Taught:	K-3 4-5 6-8 9-12 Higher Ed Other
*Subject/Area Taught:
Contact Information:	Phone: Fax:
	Very Important!! Email: Your email address submitted here will be used to give you updates on the conference. So be sure you typed it correctly! Website (if you have one):
Home Address:	Street:
	City: State: Zip Code:
School Address:	Street:
	City: State: Zip Code:
Laptop:	I am bringing a laptop with wireless capability and want to get on the campus network. I am bringing a laptop and a network cable and hope to get on the campus network. I am not bringing a laptop.
Type of Registration:	Registration US$200 Central California Conference FREE (Sponsored by Central California Conference) PUC Faculty and Staff FREE (Sponsored by Pacific Union College) PUC Prep Faculty and Staff FREE (Sponsored by PUC Prep) LLU Faculty and Staff FREE (Sponsored by Loma Linda University)
Extra Banquet Tickets:	Non conference attendees may attend the banquet. $10 tickets must be purchased in advance. Indicate number of tickets needed:
Total to be Paid:	US$ (Registration plus tickets.) If your conference registration is sponsored by your employer, you still must pay for any extra tickets requested. Please indicate your payment method (more instructions on the next page): Check upon Arrival on Campus Credit Card Online My employer authorized payment. ( Please supply contact information for your employer.) Contact Person: Email Address: Phone Number:
Housing	Housing payment should be made onsite at the Winning Hall Front Desk. I will make my own housing arrangements. I will stay in the dorm on the PUC campus. If staying in the dorm, please select one of the following choices: Gender for Housing : Male Female Guest Rooms Bedding Included & Air Conditioned Single occupancy US$48.00 /night Double occupancy US$56.00 /night Dorm Rooms Bedding & Linens Not Included $37-48 / night Extras (check all that apply) Additional person in room US$5.00 /per person per night: Name: Additional two people in room US$5.00 /per person per night: Names: Linen Package - One Time Fee US$9.00. Linen package includes 2 sheets, a pillow and pillowcase, one blanket, a hand towel, bath towel and wash cloth. Beds are not pre-made. This package is available for the guest who arrives without linen but desires the economy rate for conventions, camp meetings, and workshops. If staying in the dorm, please indicate arrival and departure dates. The conference begins Wednesday night, June 30, 2004 and concludes Friday afternoon July 2, 2004. Arrival Date: Departure Date:
Additional comments or questions:

Thank you!