Eleventh Annual Conference
May 2 – 5, 1999
Seattle, Washington

Conference Registration
Please type or print all information requested and return this form with your check made payable to PRISM, no later than April 1, 1999 to:.

Mr. Dennis Batchelder
PRISM Administrator
The Batchelder Group
11344 Coloma Rd., Ste. 505
Gold River, CA 95670

Please list any dietary restrictions or ADA accommodations you may require.
Name: _____________________________________________________
Organization: _____________________________________________________
Address _____________________________________________________
City: ____________________ State: ___ ZIP: __________
Phone: ____________________ Fax: __________
E-mail: ________________________ Check if Receipt Required
 

Please show name as it should appear on badge

  

Payment

Received by April 1, Fee $ 400
Received after April 1, Fee $ 475 Conference Attendee:
____________________________________		    
       

Received by April 1, Fee $ 100
Received after April 1, Fee $ 225
1st Guest:
____________________________________		    
       

Fee $ 225
Additional Guest:
____________________________________		  


       

Fee $ 225
Additional Guest:
____________________________________		    
       
Guest registration fee includes reception, breakfasts, Tillicum Village Cruise, and Space Needle Event


Total Due PRISM:

    
Please make your hotel reservations directly with the Madison-Renaissance Hotel, Seattle, Washington by calling 800-278-4159.  Ask for the speical rate of $150 (single/double) for group code X-PRISM.  Reservations must be made by April 1, 1999 to assure room availability at this rate.   Please see the Note about Conference Registration Fees.