2012 SCWG Conference Online Registration Form
First Name:
Last Name:
Street Address:
City, State, Zip:
Phone:
Email:
Type your email again:

Membership Status:*				Your Cost
	Current (paid) member
	Current member + Renewal	$30
	New membership	$32
	Non-member

		Member Cost	Non-Member Cost
Program:
	Full (Fri. and Sat.)	$165	$195
	Friday Only (8am-9pm)	$105	$125
	Fri. Banquet/Eve. Sessions	$40	$40
	Saturday Only	$95	$105

Agent/Editor Appointments: (SAVE on multiple appts - 3/$50)
	Jenny Bent (agent)	$20	$20
	Bethany Brown (editor)	$20	$20
	Pat McDonough (editor)	$20	$20
	Stephen Mettee (editor)	$20	$20
	Lois Winston (agent)	$20	$20
Agent/Editor Subtotal:
Extras:
	Qty: Mentoring class	$50	$50
	Qty: addl. Fri. dinner	$30	$35
	Qty: addl. Sat. lunch	$25	$25

Special Instructions:
Enter the verification key below in the box provided.			Total:
	76720