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WESTERN REGIONAL SURVEY CONFERENCE 2024
WESTERN REGIONAL SURVEY CONFERENCE 2024
REGISTRATION
REGISTRATION
______________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________
NAME (First/Last) NICKNAME or NAME (as you wish it to appear on your badge)
NAME (First/Last) NICKNAME or NAME (as you wish it to appear on your badge)
______________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________
COMPANY
COMPANY
______________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________
ADDRESS
ADDRESS
______________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________
CITY STATE ZIP
CITY STATE ZIP
______________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________
PHONE FAX
PHONE FAX
______________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________
E-MAIL
E-MAIL
______________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________
MEMBER # (Indicate: CLSA OR NALS)
MEMBER # (Indicate: CLSA OR NALS)
______________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________
SPOUSE/GUEST (if attending – see Spouse/Significant Other Registration below)
SPOUSE/GUEST (if attending – see Spouse/Significant Other Registration below)
MEMBER REGISTRATION
OPTIONAL ACTIVITIES
MEMBER REGISTRATION OPTIONAL ACTIVITIES
BY FEB 29 AFTER FEB 29 AMOUNT
AMOUNT
BY FEB 29 AFTER FEB 29 AMOUNT AMOUNT
Extra Sunday Lunch Ticket
____@ $60 $________
$325
$275
$________
PreConference Workshops
PreConference Workshops $275 $325 $________ Extra Sunday Lunch Ticket ____@ $60 $________
Extra Monday Lunch Ticket
PreConference Workshops: Saturday (all day).
____@ $60 $________
PreConference Workshops: Saturday (all day). Extra Monday Lunch Ticket ____@ $60 $________
____@ $60 $________
Extra Sunday Icebreaker Ticket
$500
Conference Only
$450
$________
Conference Only $450 $500 $________ Extra Sunday Icebreaker Ticket ____@ $60 $________
Conference Only Registration: Sunday through Tuesday.
Extra Monday Auction/Dinner Ticket
____@ $75 $________
Conference Only Registration: Sunday through Tuesday. Extra Monday Auction/Dinner Ticket ____@ $75 $________
Includes Sunday, Monday and Tuesday Luncheons, Sunday IceBreaker Reception
Includes Sunday, Monday and Tuesday Luncheons, Sunday IceBreaker Reception
and Monday Scholarship Auction.
Student Assistance Donation (Suggested Donation $25) $________
and Monday Scholarship Auction. Student Assistance Donation (Suggested Donation $25) $________
Does not include Pre-Conference Workshops on Saturday (all day
Does not include Pre-Conference Workshops on Saturday (all day).).
$________
Conference & PreConference Workshop $575
$625
Conference & PreConference Workshop $575 $625 $________
Full Conference Registration: Saturday through Tuesday
Full Conference Registration: Saturday through Tuesday. .
Includes all preconference workshops and conference registration.
Includes all preconference workshops and conference registration.
Conference One Day $250 $300 $________ PAYMENT INFORMATION
$250
$300
Conference One Day
$________
PAYMENT INFORMATION
Select Day: Sunday Monday Tuesday
Select Day: Sunday Monday Tuesday
Total Enclosed $____________
Total Enclosed $____________
NON-MEMBER REGISTRATION
NON-MEMBER REGISTRATION
BY FEB 29 AFTER FEB 29 AMOUNT
BY FEB 29 AFTER FEB 29 AMOUNT Check Enclosed (Checks payable to WRSC Conference)
Check Enclosed (Checks payable to WRSC Conference)
PreConference Workshops $375 $425 $________ Charge to: Visa MasterCard
$375
PreConference Workshops
$________
$425
PreConference Workshops: Saturday (all day). Charge to: Visa MasterCard
PreConference Workshops: Saturday (all day).
____________________________________________________________
Conference Only $550 $600 $________ ____________________________________________________________
$________
Conference Only
$550
$600
CARDHOLDER NAME
Conference Only Registration: Sunday through Tuesday. CARDHOLDER NAME
Conference Only Registration: Sunday through Tuesday.
Includes Sunday, Monday and Tuesday Luncheons, Sunday IceBreaker Reception ____________________________________________________________
Includes Sunday, Monday and Tuesday Luncheons, Sunday IceBreaker Reception
and Monday Scholarship Auction. ____________________________________________________________
and Monday Scholarship Auction.
CARD #
Does not include Pre-Conference Workshops on Saturday (all day). CARD #
Does not include Pre-Conference Workshops on Saturday (all day).
____________________________________________________________
____________________________________________________________
Conference & PreConference Workshop $675 $725 $________ EXP. DATE CVV#
$725
Conference & PreConference Workshop $675
EXP. DATE CVV#
$________
Full Conference Registration: Saturday through Tuesday.
Full Conference Registration: Saturday through Tuesday.
____________________________________________________________
Includes all preconference workshops and conference registration. ____________________________________________________________
Includes all preconference workshops and conference registration. BILLING ZIP CODE
BILLING ZIP CODE
Conference One Day $350 $400 $________ ____________________________________________________________
$400
Conference One Day
$________
$350
____________________________________________________________
Select Day: Sunday Monday Tuesday AUTHORIZED SIGNATURE
Select Day: Sunday Monday Tuesday AUTHORIZED SIGNATURE
OTHER REGISTRATION
OTHER REGISTRATION
FAX TO:
MAIL TO:
Spouse/Significant Other Registration $275 $________ MAIL TO: FAX TO: (707) 578-4406
(707) 578-4406
Spouse/Significant Other Registration
Includes badge, entrance to Exhibit Hall, Sunday Icebreaker Reception, $275 $________ WRSC Conference Office
WRSC Conference Office
Includes badge, entrance to Exhibit Hall, Sunday Icebreaker Reception,
Sunday and Monday Lunch and Monday Scholarship Auction. 526 South E Street QUESTIONS?
Sunday and Monday Lunch and Monday Scholarship Auction. 526 South E Street QUESTIONS?
Full-time Student Registration $275 $________ Santa Rosa, CA 95404 (888) 994-3510
Santa Rosa, CA 95404
(888) 994-3510
Full-time Student Registration
Must attach current student ID. $275 $________ conference@plseducation.org
Must attach current student ID.
Includes Conference Registration (Sunday through Tuesday), conference@plseducation.org
Includes Conference Registration (Sunday through Tuesday),
Sunday, and MondayLuncheons, Sunday IceBreaker Reception
Sunday, and MondayLuncheons, Sunday IceBreaker Reception
and Monday Scholarship Auction.
and Monday Scholarship Auction.
Does not include PreConference Workshops on Saturday (all day). CANCELLATIONS: - Cancel by February 29, 2024 to receive a
CANCELLATIONS: - Cancel by February 29, 2024 to receive a
Does not include PreConference Workshops on Saturday (all day). refund, less a $50 cancellation fee. After February 29, 2024 no refund
refund, less a $50 cancellation fee. After February 29, 2024 no refund
will be available but substitutions can be made. Cancellations must
will be available but substitutions can be made. Cancellations must
be made in writing by emailing conference@PLSeducation.org
be made in writing by emailing conference@PLSeducation.org
IMPORTANT - Visit Conference website, PLSeducation.org for
IMPORTANT - Visit Conference website, PLSeducation.org for
other important disclaimers and information.
other important disclaimers and information.
Register Online at: www.PLSeducation.org
Register Online at: www.PLSeducation.org
