2015 Registration Form.pub (Read

California Association of
Social Rehabilitation Agencies
May 7& 8, 2015
Recovery in Practice
Registration
A check, money order, credit card
information, or purchase order for
the full amount of the conference
must accompany each registration
form. There will be a $25 charge
for all returned checks. MAKE
CHECKS PAYABLE TO CASRA.
Concord Hilton
1970 Diamond Blvd.
(925)827-2000
Contact Information
Name
Conference
Registration
Please send completed registration
form and payment to: CASRA •
PO Box 388 • Martinez, CA 94553.
For credit card payment, fax to
925-229-9088.
Title
Organization
Address
Refund Policy
City/State/Zip
Phone #
E-mail address
Registration Fees
Please check appropriate box. For early bird rates, registration must
be postmarked or received by April 22, 2015.
Conference
Packages
Early Bird
Regular Price
By 4/22
4/23 & after
CASRA/PRA Members
USPRA Member #:
1-day 5/7
□ $175
□ $245
1-day 5/7
□ $175
□ $245
Both days 5/7-5/8
□ $350
□ $475
By registering for this conference,
you are liable for the registration fee
whether or not you attend. Refunds
will be honored provided a written
notice of cancellation is received by
April 1. All refunds will be
assessed a $25 processing fee,
which will be deducted from the
refund check. Refunds will be
processed within 6 weeks from the
date of the request.
Payment
Total Due
$
Credit Card Information
MasterCard___ Visa___ Exp:
Card number
Name as it appears on card
Non-members
1-day 5/7
□ $200
□ $270
1-day 5/7
□ $200
□ $270
Both days 5/7-5/8
□ $400
□ $525
Billing address
City/State/Zip
Consumer and Student
1-day 5/7
□ $135
1-day 5/7
□ $135
Both days5/7-5/8
□ $270
Rate applies only to
consumers and
students who are not
employed in the mental
health field.
Hotel Reservations
Call 1-925-827-2000 by April 22,
2015 and ask for the CASRA rate of
$140.