REGISTRATION for FSGW's 30^th Annual Washington Spring Ball, May 14, 2016

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

1. First: ____________________________ Last: _______________________________
2. First: ____________________________ Last: _______________________________
3. Street: _________________________________________________________________
4. City: ________________________________________ State: _____ Zip: ________
5. Email address: _____________________________  Phone: ____ - ____ - ______
   ** Legible, please **

For registrations post-marked by April 30

• Reserve |___| places @ $33 for members of |__| FSGW    |__| ATDS     |__| BFMS    |__| CDSS
• Reserve |___| places for non-members @ $38 each
• Reserve |___| places for full-time member student(s) @ $16.50    |__| @ $19 non-member students

For registrations post-marked after April 30

• Reserve |___| places @ $40 for members of |__| FSGW    |__| ATDS     |__| BFMS    |__| CDSS
• Reserve |___| places for non-members @ $45 each

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

Allergy (pets, food, other): _____________________________________________________________________

Other special needs: _____________________________________________________________________________

Please submit requests postmarked by April 30^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).