Person A Name Person B Name

Address City State ZIP

Phone Fax email

Include my name, state, phone & email in the list of attendees: Yes No

Please print out the conference brochure for workshop descriptions and cost.

Saturday workshop choices: Please mark your 1st & 2nd choices. Couples please mark choices for each attendee.
Couples may choose to attend the same or different workshops.

Payment method:      Check mailed to FRUA    PayPal

Mail Checks to FRUA C/O

Professional registration: Certificate for CEU ($15.00 to cover the cost):   Attendee A  Attendee B
          NASW or Other

Registration includes a one year FRUA membership. FRUA members receive a discount of $35 for one day or $50.00 for both days .
One discount per couple.  Register by March for a $25.00 discount.

Please see the brochure by clicking here for exact pricing.

Registration - Friday only, April 27, 2007 Single Couple Professional

Registration - Saturday Only, April 28, 2007 Single CoupleProfessional

Registration - Friday & Saturday Single CoupleProfessional

(Please remove or adjust any fees as needed)

PayPal Surcharge (PayPal charges FRUA a $6.00 transaction fee)

Early Reg Discount

FRUA Member Discount ($50.00 for both days)

CEU Fee (Professionals only)

Please add up the total and place in the box below. Incorrect amounts may result in late fees or nonattendance due to space limitations.

TOTAL

Comments and other information:

Once you submit this form then follow the PayPal link on the previous page.