WSSB Assistive Technology Summit Registration Formclipart of form

 

Class:             

Name:            

Address:         

City/State/Zip: 

 

Home Phone:  Work Phone:

Email Addresses (Home): 

Email Addresses (Work): 

 

School District:         

Your Position:          

Will you need materials in Braille or Large Print? Specify here:

 

Food selection (Enter None, vegetarian, other and explain):

 

Will you be paying by:

If Purchase Order, NUMBER:


           Registration fee:  $450
                Housing an additional $35 per night. Please include with your registration

Make check/purchase orders payable to: WSSB and indicate class title/class date on check
            Washington State School for the Blind
            2214 E. 13th St
            Vancouver, WA 98661

      You will be receiving a response soon.  Thank You!

      Any cancellations after July 6th, 2008 may result in a forfeiture of $75 of the registration fee.


NOTE: BEFORE you press "Submit" Please print this screen for your records!