1. Registration Form
California Council on Family Relations
9TH Annual Conference
Coping Through Connection: Family Resourcefulness
in Times of Challenge
APRIL 16TH 2010 8:00A.M. – 5:00 P.M., Fellowship Hall, El Centro, CA.
PLEASE REGISTER ONLY ONE PERSON ON EACH FORM.
Photocopies will be accepted. Type or print clearly your name exactly as you wish it to appear on your name badge.
This form must be fully completed.
First Name: ____________________________Middle Initial: _______ Last Name:_______________________________________
Mailing Address: (__) Business (__) Home
Street:_____________________________________________________________________________________________________
City: ______________________________________________________State:_______________ Zip/Postal/Code:_______________
Job title: ________________________________________ Employer/University__________________________________________
Phone: Business:__________________________ Home:___________________________ Cell:___________________________
E-mail Address_______________________________________________________________________________________________
University Instructor’s Signature (Students MUST have signature to get the reduced rate):
X:____________________________________________________________________________________
Non-refundable registration fees: Includes information packets, participation in the conference, continental
breakfast, lunch and refreshments during break.
*After April 13th, on-site registration only (late registration of additional $15)
Registration Fees (Before March 17th):
Student/Retiree: (___) $50 (Includes dues for CCFR membership)
Professional: (___) $90 (Includes dues for CCFR membership)
Total Fees: ( ______) (___) Cash ( __) Check (Make checks payable to CCFR)
I need special accommodations or services to fully participate in the CCFR conference. Please contact me to
discuss my
needs__________________________________________________________________________________
Send your registration and payment to CCFR P.O. Box 50-1547, San Diego, CA 92150-1547
