VALUE’s Third Adult Learner Leadership Institute
Tampa, Florida, June 26-28, 2003

Introduction
Registration Form
Things to Do While Visiting Tampa

Registration Form

Conference Registration Fees: (Please use one form for each attendee)

Please check one

Fee if registering before May 16, 2003:

___ Adult Learner, VALUE Member (ID number ______) $175.00

___ Adult Learner Organization (ID number_____) $175.00

___ Other VALUE Member (ID number ______) $185.00

___ Adult Learner, Non Member $195.00

___ Other Non Member $205.00

Fee if registering after May 16, 2003:

___ Adult Learner, VALUE Member (ID number_____) $195.00

___ Adult Learner Organization (ID number_____) $195.00

___ Other VALUE Member (ID number) $205.00

___ Adult Learner, Non Member $215.00

___ Other Non Member $225.00

___ Volunteer workers, guests, and family members attending meals, snack breaks and social events, but not conference workshops. $160.00

Florida attendees who wish to register for individual conference days, can do so at the following rates.

This fee includes all meals, breaks, workshops and social activities for that day.

Fee before May 16, 2003 Fee after May 16, 2003

___ Thursday only $ 21.00 ___ Thursday only $ 23.00

___ Friday only $105.00 ___ Friday only $110.00

___ Saturday only $ 55.00 ___ Saturday only $ 60.00

Make Checks payable to VALUE
c/o Marty Finsterbusch
2217 Providence Avenue
Chester, PA 19013

We will be limiting attendance of practitioners or non adult learners to one per three adult learners from each state.

Please print all information:

Name (as it will appear on nametag): _____________________________

Program Affiliation: _____________________________

Address________________________________________________

E-mail address__________________________________________

Telephone #___________________

For office use only: ____ _____ _____

Revised 1/15/03