LeadingAge Washington's 64th
LeadingAge
Washington’s
64th
Annual Meeting
& Conference
Be The
Voice
Annual Meeting
& Conference
JUNE (8) 9-11, 2015 • GOLF TOURNAMENT JUNE 8
SEMIAHMOO
BLAINE
WA June 8th
June (8) 9-11,RESORT,
2015 * Golf
Tournament
Semiahmoo Resort, Blaine, WA
1(855)917-3767
* Group
Name: LeadingAge
* (Cutoff
Lodging Question: Lodging?
(855) 917-3767
• Group Name:
LeadingAge
(Cutoff: May
15) May 15th )
REGISTRATION FORM Please duplicate this form for each person attending
Name:_____________________________________Title:_________________________________________
Organization: ____________________________________________________________________________
Address:________________________________________City/State:__________________ Zip:__________
Phone:_____________________________________Fax:_________________________________________
Email: (Email required for confirmation) _________________________________________________________
To assist with meal counts, please indicate the functions you plan to attend:
Tues. June 9th Breakfast___ Lunch___
“WA” American Idol Night with entertainment____ (Comp’d with registration)
th
Breakfast___ Lunch___
th
Breakfast___ Lunch___
Wed. June 10
Thur. June 11
To request Guest meal tickets, contact Cassi!
I PLAN TO HAVE ALL MEALS___!
Special Dietary Requests or Needs:_____________________________________
Registration Fees includes sessions, meals, fun night and DSHS credits. Please mark appropriate boxes.
Full Registration
Through May 29th
***10% disc
After May 29th/Onsite
___Member (M)
$565.00
$508.00
$665.00
___Non-Member (NM)
$665.00
$599.00
$765.00
___Resident, Board Member
$275.00
$247.00
$325.00
& Administrator Emeritus
Partial Registration check appropriate date and circle fee that applies
___ Tuesday, June 9
th
$285 M
$256 M
$325 M
___ Wednesday, June 10
$285 M
$256 M
$325 M
___ Thursday, June 11
$195 M
$175 M
$235 M
th
th
Optional Events
___ Golf, Mon., June 8th
$125.00 includes lunch, range balls, cart and Awards dinner at the Loomis Trail Golf Club
___ Wine Event, Mon. June 8th
$55.00 begins at Semiahmoo through the Heart of the Northern Wine Country. Includes Limo
___ Half-Day Education, Tues., June 9th
$99.00 includes lunch,
11:00 - 4:30 p.m. Half-Day specific for Activity/Wellness, Social Workers and Resident Services Directors.
Total Amount Due: $________ *** With 1 full registration, receive the 10% DISCOUNT for each addl. registrant.
Payment Method: (Print Clearly) Credit Card_____ Check attached_____ Please Invoice________
Name on CC_____________________________CC#____________________________CSC#_______
Exp. Date___________ Signature ______________________________________________________
Return to: LeadingAge Washington Mail: 1495 Wilmington Drive, Ste 340, DuPont, WA 98327
Fax: (253) 964-8876 ‫ ׀‬Email: [email protected]
$50.00 Cancellation fee after May 30th — No Show - No Refund * Replacements Welcome
Consent to Use of Photographic Images—Registration and attendance at, or participation in, LeadingAge WA meetings and other activities constitutes an
agreement by the registrant for LeadingAge to use and distribution (both now & in the future) of the registrant or attendee's image or voice in photographs,
videotapes, electronic reproductions, and audiotapes of such events and activities.