NAME______________________________PHONE NUMBER____________________
ADDRESS____________________________________________________________
CITY________________________STATE________________ZIP________________
EMAIL ADDRESS __________________________________
T-SHIRT SIZE (Adult sizes)
_____S _____M_____ L_____ XL_____XXL
Write in the amount included in the appropriate column.
| Fee | Total | |
| Pre-Registration (Postmarked by March 1, 2001) includes: Attendance to sessions, T-shirt & lunch) | $55 | |
| Registration after March 1, 2001 | $65 | |
| Additional T-shirt | $10 | |
| Lunch | Included | Included |
| .7 Continuing Education Units | $7 | |
| 7 Clock Hours | $21 | |
| One CWU Professional Development Credit | $40 | |
| TOTAL |
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
Office of Continuing Education
400 E. 8th Ave.
Central Washington University
Ellensburg, WA 98926-7433