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African American Storytellers’ Retreat 2012 Mail-In
On-line Registration Form open a blank page on Microsoft Word,
come back to this form, go to edit
click select all,
place cursor on the form and right click copy, go back to Word and right click
paste.
Print
and mail in the completed registration form.
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Pre Registration Due by
May
1, 2012
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Contact Information
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Adult Registration
(non NABS or non Affiliate members)
_____@ 275.= _______ |
First Name
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Youth Registration (Ages 7 - 21)
_____@ 225.= _______
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Last Name
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Elder Registration (55+ no other discounts apply)
_____@ 250.= _______
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Address
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NABS and Affiliate Registration (no other discounts apply Must
show membership card)
_____@ 250.= _______
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City
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Late Registration (After May 1, 2012)
_____@ 285.= _______
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State and zip code
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Total Registration __________
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Email address and Phone Number
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Check___ M.O.___
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T-Shirt Size: (circle one or add size)
S M L XL 2X 3X 4X ______
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Mail To: AASAI
3213 Duke Street # 629 Alexandria, VA 22314
703.684.8587 919.673.2507 E Mail griot9@blackstory.org |
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