<p>Washington School Counselor Association & Office of Superintendent of Public Instruction Comprehensive Guidance & Counseling Summer Institute June 24 & 25, 2014 Red Lion Hotel, Olympia, WA</p><p>Registration </p><p>Name ______</p><p>Home Address______</p><p>City ______State______Zip______</p><p>Phone______Cell phone______</p><p>E-mail______</p><p>District______</p><p>School ______</p><p>Special Diet______</p><p>WSCA Member ____$99.00 Non Member ____$125.00</p><p>Payment type: __ Check Number ______</p><p>Purchase order __ Purchase order Number ______</p><p>Credit Card __ VISA __ MC __ AMEX __ Discover</p><p>Card #: ______</p><p>Exp: ______CVS # (from back of card) ______</p><p>Name on card:______</p><p>Signature:______</p><p>Billing Address if Different than above: </p><p>Address______</p><p>City ______State______Zip______</p><p>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 </p>