Name __________________________________________________

Spouse's Name ____________________________________________

E-Mail Address ______________________ Phone (____)___________

Address _________________________________________________

City __________________________ State _____ ZIP _____________

Children's Names and ages     __________________________

_________________________      _________________________

_________________________      _________________________

First time at Bryan? ____Yes ____No *If yes, please indicate if someone encouraged you to come. (They may be eligible for a discount)

_______________________________________________

Enclosed registration fee $____________

Enclosed Donation $________________

Conference T-Shirt (if desired) - Indicate qty. and sizes (YS thru 3XL)

Navy _________ x $10 = $_________
Pink  _________ x $10 = $_________

Please indicate room choices below