| REGISTRATION FORM |
| Please complete the form below. |
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| It is necessary for correct price calculations that you use the TAB key to move through the fields on this form |
| or click on the Total Due Field before clicking Submit. |
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| Number of Days Attending: |
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| Day(s) Attending: Do NOT mark any days if you selected Full Conference. |
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| Lagniappe: Ordering from this section ends February 28. Any items selected from this section after February 28 will not be filled. |
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| A Syllabus on CD will be provided to every registrant. |
| You may choose to receive a printed copy, or a flash drive for $25.00 |
| Click here to indicate if you wish to receive these "extra" items. |
| Syllabus on Flash Drive |
| Printed Syllabus |
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| Pre-Order Books: |
| A limited quantity of the books designated with an asteriisk will be available in the conference bookstore. |
| All other books are available by pre-order only. |
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| Please help us ensure adequate seating by clicking the button for each and every General Session you plan to attend. |
| Wednesday, March 23, 2011 |
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| 5:00 – 6:30 PM Free Time: Hotel Check-In, Dinner On Own |
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| Thursday, March 24, 2011 |
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| Thursday Breakouts (Choose ONE) |
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| 12:00 - 1:00 PM: Thursday Luncheon (Please indicate choice) |
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| 2:45-3:15 PM Dessert and Coffee break |
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| 4:45 PM Free Time/Dinner: (Choose ONE) |
| ALL SPEAKERS Please Select - Speaker Dinner @ Mulates!! |
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| Friday, March 25, 2011 |
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| 10:30 -11:30 AM Friday Breakouts: (Choose ONE) |
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| 11:45 AM - 12:15 PM Award Luncheon with Dessert, Baby Wearing Fashion Show: (Indicate Choice of Meal) |
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| 2:30-3:00 PM Closing Session: Evaluations/wrap up/door prizes |
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| Breakfast Tickets: (For those not staying @ the Hampton) |
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| Extra Lunch Tickets: |
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| The following may receive a discounted price: |
| General Public not requiring Continuing Education Units: |
| La Leche League Leaders |
| WIC Breastfeeding Peer Counselors |
| Students with valid ID |
| Select the days you are attending from the list below: |
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| Conference Speakers:
Please indicate the days you are attending..... |
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| Make all checks payable to: LLL AL/MS/LA |
| PayPal payments may be sent to: almsla@yahoo.com |
| Please Print this page for your records before clicking the SUBMIT button. |
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