Form

Address*

Emergency Contact Name
First Name Last Name
Emergency Contact Phone Number
- Area Code Phone Number
ASWA Member?*

Yes No
Chapter Name:
Chapter Office or Committee:
Guests' Names (if any):
Complete Registration (includes Thursday and Friday CPE sessions, breakfast & lunch):

ASWA Member - $225 Non ASWA Member - $275 Student Registration (Student ID Required) - $125 Early Registration Discount (Deadline April 15th) - ($25)
Partial Registration:

Thursday Only - $150 Friday Only - $150 Early Registration Discount (Deadline April 15th) - ($25)
Event & Guest Registration:

Fun Night - Wednesday - $40 Fun Night - Wednesday - $40 Fun Night - Wednesday - $40 Fun Night - Wednesday - $40 Friday Luncheon - additional guest charge - $35 Friday Luncheon - additional guest charge - $35 Friday Luncheon - additional guest charge - $35 Friday Luncheon - additional guest charge - $35 Golf Tournament - Saturday - $75 Golf Tournament - Saturday - $75 Golf Tournament - Saturday - $75 Golf Tournament - Saturday - TEAM - $275
Any additional comments?
Make Checks Payable To:

ASWA Mesa East Valley Chapter
Mail Registration Form and Check To:

ASWA PO Box 41491, Mesa, AZ 85274
Online Credit Card Payment Available at:

http://www.aswa-mev.org/2012swrc/94.html
Should be Empty:

ASWA Southwest Regional Conference RSVP