with PAYMENT to SCBWI Arizona
SCBWI AZ
Health and Creativity Day
P O Box 26384
Scottsdale, Arizona 85255
_________________________________________
REGISTRATION FORM
Health and Creativity Day
Saturday, February 11, 2012
8:30 AM - 3:00 PM
NAME:____________________________________
E-MAIL:___________________________________
Confirmation will be sent via E-Mail
MAILING ADDRESS__________________________
CITY_____________STATE___________ZIP______
LAND PHONE_______________________________
CELL PHONE_______________________________
SCBWI Member* Yes__________ No _________
*Proof of Membership You may include a copy of your
current membership card as proof of membership. You may also login to www.scbwi.org click on
Membership Renewal and then print a copy of the page
that shows your membership expiration date.
SCBWI MEMBER EARLY BIRD RATE: $35.00 __________
NON MEMBER EARLY BIRD RATE: $40.00 _________
SCBWI MEMBER LATER BIRD RATE: $40.00 __________
NON MEMBER LATER BIRD RATE: $45.00 _________
My check made payable to SCBWI Arizona is enclosed._
Check #_________ Bank ______