Registration Deadline - July 13, 2012

Where did you learn about Edufest:     attended before  /  friend  /  flier  /  other

Title:   Mr. / Mrs. / Ms. / Dr. 

Name (please include first and last)_________________________________

Preferred Name (if different than given):_____________________________

Home Address __________________________________________________

City ___________________________ State _______ Zip ________________

Home Phone ___________________________________________________

Email Address __________________________________________________

School District___________________________________________________

School ________________________________________________________

Conference Options – Please check all that apply
___ $460 Week-long Conference Fee:  All sessions, snacks, and Thursday banquet

___ $120 Meals: All meals Monday morning until Friday morning

___ $170 Housing: Single occupancy dorm room, no private bath

___ Female     ___ Male      

       Preferred Roommate(s) ________________________________________

___ $15   Credit Card Fee: for week-long participants using a credit card

___ -$25 Early Registration Discount (postmarked by June 1st, 2012 – Week-long conference only)

___ $15   Parent, Administrator, Counselor Night:  Tue., July 24,  7-8:30 PM

___ $10   Second parent to attend Parent, Administrator, Counselor Night:  (interested in same child)

___ $ 5    Additional Registration for Parent, Administrator, Counselor Night after July 13th, 2012

___________ TOTAL (add up all checked options)

Method of Payment  (at least a $100 deposit per person with this form)

_____ Check payable to Edufest

_____ Purchase Order Number _________________  Amount ________

_____ Credit Card     Cardholder’s Name:__________________________

Credit Card Number: __________________________________________

Amount to be charged: __________  Card Type: ____________________

Security code: ________   Signature:______________________________

Make check or purchase order payable to Edufest and mail to
Edufest, PO Box 45086, Boise, ID 83711-5086     Fax 208-378-0579