NAME______________________________PHONE NUMBER____________________
ADDRESS____________________________________________________________
CITY________________________STATE________________ZIP________________
EMAIL ADDRESS __________________________________
T-SHIRT SIZE (Adult sizes)
_____S _____M_____ L_____ XL_____XXL
Write in the amount include in the appropriate column.
| Fee | Fee Included | |
| Pre-Registration (Postmarked by March 1, 2002) includes: Attendance to sessions, T-shirt & lunch) | $55 | _____ |
| Registration after March 1, 2002 | $65 | _____ |
| Additional T-shirt | $10 | _____ |
| Lunch | Included | |
| .7 Continuing Education Units | $7 | _____ |
| 7 Clock Hours | $21 | _____ |
| One CWU Professional Development Credit | $40 | _____ |
Charge my credit card: MC/VISA#___________________________________________
Expiration Date______________________
Card Holder's Name_____________________________________________________
Signature____________________________________________________________
Make checks payable to: Central
Washington University.
Fill out and send to:
Physical Education Activity Kaleidoscope
400 E. 8th Ave.
Central Washington University
Office of Continuing Education
Ellensburg, WA 98926-7433