Az Hosa Fall Leadership Conference Registration Form

AZ HOSA FALL LEADERSHIP CONFERENCE REGISTRATION FORM November 13, 2008

Phoenix College, Phoenix, AZ

Chapter Number ______

Advisor ______School Phone ______

School ______School Fax ______

School Address ______E-mail ______

City ______, AZ Zip ______Phone ______

Cell Phone: ______

Registration Deadline: October 20, 2008

Late Registration Deadline: October 31, 2008

Late Registration Fee: $40.00

1.  E-mail this completed form to or or fax to 602-364-4035 on or before October 20, 2008.

2.  Make checks out to “AzHOSA”

3.  Send a copy of registration form with payment by November 3, 2008 to:

Jane Shovlin

AzHOSA

1535 W. Jefferson St Bin #42

Phoenix, AZ 85007

4.  Keep one copy for your files.

The Conference Registration fee is $28.00 per student, chaperones and advisor.

The required ratio for adult supervision of students is 1 adult per 10 students.

NUMBER OF PARTICIPANTS: Students ______x 28.00 = _____

Advisors ______x 28.00 = _____

Chaperones ______x 28.00 = ______

Total Fee Due______

Tee Shirt Sizes

Small ______

Medium ______

Large ______

X-Large ______

XX-Large ______

TOTAL ______

SS = Secondary member, AD = Advisor, CH = Chaperone

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Duplicate form as needed.

Registration Deadline: October 20, 2008

Late Registration Deadline: October 31, 2008

Late Registration Fee: $40.00

Revised 8/2007 Page 2