Individual Registration

Register Here!

Online Conference Registration Form
Individual Registration ONLY

Please complete the following form to register for the Alaska Family Child Care Association's 22nd annual Child Care Conference "Gardening Generations" April 29th and 30th, 2011 at the Sheraton Anchorage Hotel and Spa.

First Name:
Last Name:
Name Tag:	Please indicate how you wish your name to appear on the conference attendee name tag.
Facility Name/Agency:
Address Street 1:
Address Street 2:
City:
State:
Zip/Postal Code:	(5 digits)
Business Phone:
Home Phone:
Email:
Verify Email:
AFCCA Member?	Are you a member of the Alaska Family Child Care Association?
Please Note:	We will verify your current membership status. If your membership has expired, please choose the following options:
	Bill me $35.00 for Individual Membership in addition to my conference registration at the member rate.
	Charge me the non-member conference rate.
	Notify me, please do not process my registration.
	Do you wish to become a member of the Alaska Family Child Care Association?
	Yes, Bill me $35.00 for Individual Membership in addition to my conference registration at the member rate.
	No, Bill me at the non-member conference rate.
Current AFCCFP Participant?	I am a current AFCCFP participant entitled to a $5.00 Membership discount on the membership selected above. NOTE: This discount only applies to current participants claiming food program reimbursements with the Alaska Family Child Care Food Program in Anchorage. AFCCFP is proudly sponsored by AFCCA.
Conference Registration:
Details: Early Bird: Must submit before March 15, 2011	Full Conference: Member $175.00 Early Bird or $200.00 Non-Member $200 Early Bird or $230.00 Friday or Saturday Only: Member $110.00 Early Bird or $120.00 Non-Member $120.00 Early Bird or $150.00
Meals included in Registration:	Light breakfast will be served 8:00 am. Lunch will be served 12:00 pm.
Special Meal Arrangements:	Please indicate if you need special Meal Arrangements?

Note any Food Allergies or Meal Restrictions

Billing Information:
Name on Credit Card:
Credit Card Number:	Please indicate your credit card number without dashes or spaces.
Card Expiration:
Security Code:	Please indicate the three digit security code on the back of the card.
Billing Address:	Billing Address same as above. If not, please indicate it below.
Billing Address:

dsk 3-8-2010