INVEST IN READING CONFERENCE REGISTRATION FORM For the 61st West Virginia Reading Association Conference November 17-18, 2016 The Greenbrier, White Sulphur Springs, WV Pre-registration using this form with payment will be accepted until October 15, 2016. Mail your completed form to: WVRA Conference Registration P.O. Box 382 Craigsville, WV 26205 You can also register online using a purchase order or credit card at regonline.com/investinreading

For any additional questions, contact Aleda Hileman at [email protected]

PLEASE PRINT – ALL FIELDS REQUIRED-COMPLETE ONE FORM FOR EACH REGISTRANT Last Name First Name Date

Street or Route and Box Number Home Phone

City State Zip Email Address

Work Phone Position

Local Council (County) County of Residence IRA Member (Circle One) Yes No

CONFERENCE INFORMATION AND FEES Please check applicable fees if using this form. For credit cards only, use on line form at www.regonline.com/investinreading Super Saver Pre-Registration (postmarked by Oct. 15, 2016) $100.00 Use online site to register Online www.regonline.com/investinreading (before Oct.15, 2016) $110.00 Regular Registration (after Oct. 15) and at the Conference $160.00 Super Saver Student Pre-Registration (postmarked by Oct. 15th ) $40.00 Student Regular Registration and at the Conference (After Oct.15) $50.00 Author Luncheon-Thursday-TBA $45.00 Author Luncheon – Friday - TBA $45.00 TOTAL Please note: Membership is included in the registration fee. METHOD OF PAYMENT No Purchase Orders can be accepted after September 30, 2016. Purchase Order (Must accompany this form) PO# ______Amount $______Purchase Order issued by: Name ______Address______Full Payment of Purchase Order must be received by October 30, 2016

NO CREDIT CAN BE EXTENDED Personal Check/Money Order # ______Amount $ ______County/School Check # ______Amount $ ______Make Checks/Purchase Orders for the total amount payable to the West Virginia Reading Association

REFUND POLICY: APPLICATIONS FOR REFUNDS MUST BE RECEIVED IN WRITING BY OCTOBER 30, 2016. REFUNDS DUE TO INCLEMENT WEATHER CANNOT BE ISSUED. THERE WILL BE A PROCESSING CHARGE OF $20.00 FOR ALL REFUNDS.