A Day with Dr. Tim Field

Attendee Registration Form

Saturday l June 14, 2008
PCC Workforce Training Center Auditorium

1626 SE Water Avenue ~ Portland, Oregon

Registration fee includes a box lunch (please select).

Registration Fees

	By June 1st	After June 1st
OARP Member	$89.00	$135.00
Non-Member	$109.00	$135.00

Graduate Student*	$25.00

* To qualify for the Graduate Student rate, you must already have a bachelors degree and be currently enrolled in a graduate studies program at an accredited university.

To Register Online, Complete

& Submit This Form

Company Name:
(School name if registering
as grad student)

Student ID: (if registering as grad student)

Street Address:

City	State	ZIP

Registrant First Name:

Registrant Last Name:

Contact Email:

Contact Phone:

Contact Fax:

Select Registration Fee:

Select Lunch Box Choice:

Select Payment Method:

Send Invoice to:

Bill To Contact Name

Bill To Company Name

Bill To Street Address

Billing City	Billing State	Billing Zip