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2011 CAMPUS EDUCATION WEEK EARLY REGISTRATION FORM

(This form is for early program registration through August 12, not for campus housing.)

For optimum accuracy, please print capital letters in black ink and avoid writing on the lines. Submit one completed form for each individual. Students must be 14 or older. Registration by mail is due by Friday, August 5, 2011; the in-person early registration deadline is Friday, August 12, 2011, at 5:00 p.m. Please do not staple or tape checks/money orders to registration form. Duplicate this form as needed.

Program registration is also available by telephone, 801-422-8925 or toll-free at 877-221-6716, and by Internet at http://educationweek.byu.edu.

Male Female

Last Name

First Name

Middle Name

Mailing Address (include apartment number if applicable)

City (include province for foreign address)

U.S. State

Zip Code

Country if not U.S.

Foreign Postal Code

(

)

-

/

/

Daytime Telephone

Birth Date (MM/DD/YY)

E-mail Address

Using black ink, darken only one circle.

EARLY REGISTRATION TUITION THROUGH AUGUST 12:

$64 Monday–Friday Full Day $54 Tuesday–Friday Full Day $61 Senior Citizen Monday–Friday Full Day (62 and over) $51 Senior Citizen Tuesday–Friday Full Day (62 and over)

$24 Tuesday–Friday Mornings Only (8:30 a.m.–12:05 p.m.) $24 Tuesday–Friday Afternoons Only (12:30–4:05 p.m.) $24 Tuesday–Friday Evenings Only (4:30–9:25 p.m.)

$16 Monday Only Full Day (8:30 a.m.–4:05 p.m.)

Signature Cards may be purchased by telephone or Internet only through July 22. (See page 55.)

AGAIN in 2011 $29 Tuesday–Friday Marriott Center Only (8:30 a.m.–4:05 p.m.)

Make checks payable to Campus Education Week. Total check amount enclosed for this registration:

$

.

To t a l

Bank card payments are not accepted with mail-in registrations. Bank cards may be used for telephone and Internet registrations through August 12.

Payment must be made in U.S. funds drawn on a U.S. bank. Canadian postal money orders in U.S. funds are also accepted.

Mail to: Campus Education Week Registration, 120 Harman Continuing Education Building—BYU, PO Box 21531, Provo, UT 84602-1531 EARLY REGISTRATION ONLY—PLEASE RETURN FULL PAGE WITH PAYMENT

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