Registration Form

Name:___________________________________________________

Address:_________________________________________________

City, State, Zip:___________________________________________

Daytime Phone:___________________________________________

Email:___________________________________________________

Please Note: There are no food vendors nearby. You are welcome to bring your own lunch. Registration for lunches and/or Friday night reception must be in before Feb. 23rd.
Early registration, must be postmarked Feb. 23th
Reception Fee	___ at $20	= ______
Conference fee:
Senior/student	___ at $20	= ______
Senior/student+reception	___ at $40	= ______
Senior/student+reception+lunch	___ at $55	= ______
General	___ at $30	= ______
General+reception	___ at $45	= ______
General+reception+lunch	___ at $65	= ______
Registration after Feb. 23th	___ at $40	= ______
Total enclosed		= ______
Reception and Conference are at the Museum of History and Industry – 2700 24th Avenue East. Parking is free. Call 206-324-1126 for directions

Make Check out to PNW Historians Guild and send to:
PNW Historians Guild
4843 50th Avenue S.W.
Seattle, Washington 98116