Registration Form

Name:___________________________________________________

Address:_________________________________________________

City, State, Zip:___________________________________________

Daytime Phone:___________________________________________

Email:___________________________________________________

Institutional Affiliation:______________________________________

Number of Registrants:	________________________
Early Registration (before February 27th)	___ at $30 each	= ________
Registration after February 27th	___ at $40 each	= ________
Students, Seniors and Presenters	___ at $20 each	= ________
Lunch Buffet – Lunches may be ordered only with early registration.	___ at $12 each	= ________
Total enclosed		= ________
You are welcome to bring your own lunch. No restaurants are within walking distance of the museum.

Please make checks payable to MOHAI
Send check with this form to:

2700 24th Ave. East
Seattle, WA 98112

For more information or to register by phone call 206-324-1126.