November 4-5, 2011 Marriott Hotel Charleston, WV
Name ________________________________________________________
Address _____________________________________________________
County _______________________________________________________
City _________________________________________________________
State ____________________________________
Zip ______________________________________
Phone (H) ________________________________
Phone (W) ________________________________
E-mail ____________________________________
Registration Category:
Member/per person rates
_____$50 double _____$80 single _____$30 commuter
Non-member rate/per person rates
_____ $100 double _____ $150 single _____ $60 commuter
Roommate’s Name: (if applicable) ____________________________________
Make checks payable to WVEA PIC Conference and mail to: WVEA/PIC 1558 Quarrier Street Charleston, WV 25311 For further information contact Kym Randolph at 1.800.642.8261 extension 211 or Anita Maxwell at 1.800.642.8261 extension 116.
REGISTRATION DEADLINE: October 21, 2011