AABSS Mail-In Payment Form

Please print & complete this form and send in along with your check.

Make checks payable to AABSS

Mail to:  AABSS

              24 W. Xenia Ave/ PO Box 24

              Cedarville, OH 45314

Included in your registration fee is all sessions (AABSS, CARE & EQRC), up to 12 CEU credits, pre-conference workshops, and coffee breaks.

First Name:______________________________________

Last Name:_______________________________________

Email Address:_____________________________________

Phone Number:_____________________________________

⃞   Presenting or

⃞   Attending only

Payment Selection [Choose One]:

⃞   $260 Non-student rate

⃞   $180 Student & Retiree rate

⃞   $80 UNLV (faculty/staff or student) rate