Conference Online Registration Form - Texas State Reading Association

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Contact TSRA

PO Box 16887

Lubbock, TX 79490
Phone: 512.554.9300
Fax: 806.368.8619
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Conference Online Registration Form

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Fields with * are required.

First Name: *
Middle Name:
Last Name:
Home Phone Number: *
Fax Number: *
Nickname for Badge: *
School Name:
Preferred Mailing Address: *
E-mail Address: *
City/State/Zip: *
Current TSRA Member:	Yes No
TSRA Number (if known):

Registration Fee:

TSRA Member(FullRegistration):

Non- Member(FullRegistration):

One Day Pass
Friday Saturday

New- Member(Include TSRA Membership):

Student Registration

Student Day Pass
Friday Saturday

Conference Special Events

TSRA Awards Luncheon (Friday)

Book and Author Luncheon (Saturday)

Total:

Method of Payment

Pay by check made payable to: TSRA

Check #:

Amount:

Pay by school PO made payable to: TSRA
Original PO should be faxed to: 1.512.252.1750

PO #:
Amount:

Pay by credit card made payable to: TSRA
Master	Visa	AMEX	DISC

Name on Credit Card:
Credit Card Number:
Expire Date:
Billing Address:
Signature:

Conference Online Registration Form

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