Washington School Counselor Association

Washington School Counselor Association & Office of Superintendent of Public Instruction Comprehensive Guidance & Counseling Summer Institute June 24 & 25, 2014 Red Lion Hotel, Olympia, WA

Registration

Name ______

Home Address______

City ______State______Zip______

Phone______Cell phone______

E-mail______

District______

School ______

Special Diet______

WSCA Member ____$99.00 Non Member ____$125.00

Payment type: __ Check Number ______

Purchase order __ Purchase order Number ______

Credit Card __ VISA __ MC __ AMEX __ Discover

Card #: ______

Exp: ______CVS # (from back of card) ______

Name on card:______

Signature:______

Billing Address if Different than above:

Address______

City ______State______Zip______

Send registration to: Chris Kelly, 8322 110th Street East, Puyallup, WA 98373 Fax to (253)445-6114 or Email [email protected] Questions: 253-445-0541 or 253-820-6982