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Eastern Iowa Home School Conference

“Creativity in Your Home and Home School”

Registration

May 16, 2009 8 am-5 pm

Lunch Included (Circle one) Chicken Beef Vegetarian Gluten free

Name:__________________________________________________________________

Mailing Address:________________________City_____________State__Zip_______

Phone:____________________________________Email:_______________________

Cell:_____________________________Alternate:______________________________

Early Fee Enclosed $25.00________ Partner $15.00_____

After 4/26/09 $30.00________Partner $20.00_____

Fees paid online ____ http://eihsconference.pbwiki.com/Paypal-Payments# with Paypal

Affiliations: HSAP and/or Support groups:

________________________________________________________________________

________________________________________________________________________

This information is gathered for statistics only

Mail to:

EIHSC c/o

Village Home School

1466 Walker Way

Coralville IA. 52241