Registration Form

Name(s): _______________________________________________________

Address: _______________________________________________________

City:_______________________________ State: ______Zip: _____________

Phone:_______________________E-mail: ____________________________

In lieu of charging registration fees, we are suggesting a donation of $20 per person. Proceeds of this convention will go to the Planetarium Replacement Fund at Washburn University.

Number of people: ___ X $20 per person (or other amount) = _____

Dorm fees (see information on dorms) = _____

Number of BBQ meals (drinks not included) ____ X $7.50 = _____

Number of banquet (buffet) meals ____ X $15 = _____

Total enclosed = _____

Do you need information on camping? ____

Do you need hotel/motel information? ____

Make checks payable to: 

AAAC-Brenda Culbertson

and mail to 

4021 SW 10th St. #232

Topeka, KS 66604