Registration Deadline: February 11, 2005

Name: ___________________ Organization: _________________
Address: __________________________________________
City: ____________________ State: _____ Zip Code: ____________
Telephone Number(s): __________ _______________________
Fax: ____________________ E-mail: __________________

The following prices include all activities during the conference (proceedings, registration, Friday and Saturday night lodging, two breakfasts, and the banquet Saturday night):

______ Single Room $275.00 per professional, $255.00 per student

______ Double Room $195.00 per professional, $175.00 per student

______ Triple Room $170.00 per professional, $150.00 per student

______ Quad Room $150.00 per professional, $130.00 per student

The following prices are for one night, the proceedings, registration, banquet, and one breakfast:

______ Single Room $145.00 per person

______ Double Room $105.00 per person

______ Triple Room $90.00 per person

______ Quad Room $80.00 per person

The following are for storm conference attendees for no lodging:

______ Price for registration, proceedings, banquet and no lodging is $70.00

______ Price for the conference attendance alone (registration, and proceedings, but no banquet and lodging) is $40.00

The following is for guests who are not attending the conference:

______ Price for two night lodging and two breakfasts for spouses, children, or guest not attending the conference and sharing a room with a conference attendee is $90.00 one guest, $85.00 for two guests, and $75.00 for three guests – per guest.

______ Price for the banquet only is $35.00

(Please continue on other side)

The banquet includes a choice of the following (choose one) –

______ Chicken Carazella- Breaded and Sauté ed with Southwestern Spices w/ Maple Red Pepper Sauce
______ Sliced Tender Roast Beef with Smoked Bacon Gravy
______ Farfalle Pasta w/ Portabella Mushrooms & Asparagus in Sun-dried Tomato Cream Sauce

If you are sharing a room, please list roommate(s) below:

1._____________________________________________ 2. ___________________________________________________

3. _____________________________________________________________

If presenting a paper or poster session, please check off the following and deduct it from your total fee:
______ $10.00 for paper presentation

Preferred presentation time: (no preferences? – ask what times you cannot present)
______ Saturday AM time slot
______ Saturday PM time slot
______ Sunday AM time slot

______ $5.00 reduction for poster presentation

Display time:
______ Saturday only
______ Sunday only
______ Saturday and Sunday

Title of paper or poster presentation: ______________________________________________________

Type of audio or visual equipment needed for presentation: ________________________________

Total Amount Enclosed: $________________________

Make checks payable to: LSC-AMS & NWA and send it before Friday, February 11, 2005 to:

** Due to financial planning, anyone who needs special-needs assistance during the conference must contact the LSC-AMS & NWA before January 14, 2005 **