Name:______________________________________________________

Spouse’s Name: ______________________________________________

Street: ______________________________________________________

Apt #: ______________________________________________________

City: ____________________ ST: _____ ZIP: ____________

Phone: ____________________ Email: _________________________

Children’s Names (all those attending conference):

______________________________ Age: _____         Gender _______

______________________________ Age: _____         Gender _______

______________________________ Age: _____         Gender _______

______________________________ Age: _____         Gender _______

Expected Arrival Date: ____________________  Expected Departure Date: __________________

 Cost:

Day Commuters…………………………………..$65

Single Adults (Age 16+) ………………………..$180

Single Parents with 1 child .……………...……..$250

Single Parents with 2 Children ………….……..$320

Couples without children .…………………...….$360

Couples with 1 Child ………………………...…$430

Couples with 2 Children (4 -15 yrs) …...…...…..$500

Parents with more than 2 children add $60 per child.

                                                Make checks payable to KCFA

Note:

**Commuter cost does not include room or meals.**

• Pre-registration fee is $25. The fee will applied to the total cost of the conference.

• Pre-registration deadline is JUNE  15, 2011. After June 15, on site registration will be accepted only as space is available.

• Pre-registration fee is non-transferable and non-refundable.

• The above cost covers room, board, and meals for the duration of the conference.

• There will be a $20 key deposit refundable at the end of the conference when key is returned.

Signature: ___________________________ Date: ______

Amount Enclosed: ______________________

Visit us on the web at WWW.KCFA.NET

919-803-1696