REGISTRATION for FSGW's 27^th Annual Washington Spring Ball, May 18, 2013

NAME(s) as they are to appear on name tags (please print legibly)

First: ____________________________ Last: _______________________________

First: ____________________________ Last: _______________________________

Street: _________________________________________________________________

City: ________________________________________ State: _____ Zip: ________

Email address: _____________________________  Phone: ____ - ____ - ______
** Legible, please **

• Reserve |___| places @ $32* for members of |__| FSGW    |__| BFMS    |__| CDSS
• Reserve |___| places for non-members @ $35 each
  ^* Add $6 per person for registrations postmarked after May 4^th
• Reserve |___| places for student(s) 1/2 price $16 (members)
  $17.50 (non-members)^*  (Add $3 for student registrations postmarked after May 4)

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|__| Desire overnight hospitality — |__| Non-smoking    |__| Separate Beds

Allergy (pets, food, other): _____________________________________________________________________

Other special needs: _____________________________________________________________________________

Please submit requests postmarked by May 4^th to facilitate coordination of requests.

I / we can provide overnight hospitality for __________ visitors (please provide your email address, above, to facilitate coordination of this activity).