Autism Through the Lifespan:
Living an Exceptional Life

Friday, April 30, 2004
Hyatt Regency Islandia - San Diego

15% Discount to Parties of 3 or More
(All members of party must register at same time)
 
Registrant Information
             
Registrant 1   Registrant 2  
First Name     First Name  
Last Name     Last Name  
Title     Title  
Organization     Organization  
Address 1     Address 1  
Address 2     Address 2  
City     City  
State     State  
Zip     Zip  
             
Phone       Phone    
Email Address     Email Address  
             
Registration     Registration  
Lunch Choice     Lunch Choice  
             
             
Registrant 3   Registrant 4  
First Name     First Name  
Last Name     Last Name  
Title     Title  
Organization     Organization  
Address 1     Address 1  
Address 2     Address 2  
City     City  
State     State  
Zip     Zip  
             
Phone       Phone    
Email Address     Email Address  
             
Registration     Registration  
Lunch Choice     Lunch Choice  
             
             
Payment Information
     
Name  
    Please enter name as it appears on card.
Card Number  
Expiration Date      
     
Billing Address  
City  
State  
Zip  
Phone  
     
     
Cancellation Policy: Cancellations in writing, postmarked by April 15th, 2004, will be refunded, less $25. No-shows are responsible for full registration fee. Substitutions will always be accepted.
Your total is $ .
(If checked, your discount has been applied.)
 
 
Registration Deadline: Online registrations must be received by 5:00 pm on April 27th. Registrations after that date can be made at the door.
 
 

TERI, Inc.
3225 Roymar Road, Oceanside, CA 92054
(760) 721-1706 / (760) 721-9872 fax
www.teriinc.org
tracyk@teriinc.org

Design: Matt Luckey Illustration & Design