Wufoo

Date
July 6 - 9, 2011
Location
West Virginia Wesleyan College
Name * First Last
Grade 2011-2011 *
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Contact Phone Number * ### - ### - ####
Contact Email (not published)
Birthday MM / DD / YYYY
Gender *
Registration Fees $ Dollars . Cents
Early Bird Price (postmarked by May 20, 2011) $200
Registration (postmarked by June 20, 2011) $210
Late Registration (June 21 - July 6) $225

You may make partial payments.

Cancellations must be received by June 1 for full refund!

Make checks payable to WVASC.
After you SUBMIT form you will receive a confirmation email. Please print email and mail with payment to Allan Keener, 16 Tiger Trail, Fairmont, WV 26554
School Name, Advisor Name, Tshirt Size and Roommate preference
Do Not Fill This Out

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