Registration Form

Make checks, money orders, or purchase orders payable to the Florida Secondary Reading Council.

Name ________________________________________________________________________

Home Address _________________________________________________________________

City State Zip  _________________________________________________________________

E-mail _______________________________________________________________________

Home Phone ( ) _______________ School Phone ( ) ___________________

Affiliation ______________________________ District _____________________________

School Address _________________________________________________________________

City State Zip  _________________________________________________________________

Early Bird Registration (postmarked by April 8, 2005)

______ $ 75: Friday, April 22 only

______ $ 75: Saturday, April 23 only

______ $100: Friday and Saturday

Student Registration (proof of student status required)

_____ $ 25: Friday, April 22 only

_____ $ 25: Saturday, April 23 only

_____ $ 50: Friday and Saturday

Regular Registration (On-site registration)

______ $100: Friday, April 22 only

______ $125: Friday and Saturday