WVAGT Conference Registration Form

Name:  _________________________        E-mail:  _________________________

Address:  ____________________________________________________________________

City, State:  ________________________        Zip Code:  _________________________

County in which you work:  ____________________________________________________

My primary interest in attending this conference is as a:  ____ parent, ____ teacher of the gifted, ____ classroom
teacher, ____ administrator, ____ exhibitor/vendor, ____ other

Please contact Lakeview at 1-800-624-8300 for hotel reservations.  Refer to WVAGT to receive the discount of $84 per
room, single or double.  Rooms are saved at our group rate until September 22, 2010.

WVAGT Membership (  ) New        (  ) Renewal

Conference Registration Fees

* * * Special Deal!  Register early, before September 1st, 2010, for our Early Bird Special!!

       Fall Conference & Membership for 1 year Early Bird Special----- $100 (includes meals)
       Fall Conference & Membership received after October 5th-------- $110
       Friday or Saturday Continental Breakfast-----------------------------   $8.00
       Friday Guest Lunch -------------------------------------------------------- $16.00
       Friday Guest Dinner ------------------------------------------------------- $28.00
       Membership Only ------------------------------------------------------------$20.00
       Vendor Fees--------------------------------------------------------------------$50.00

Dinner Options:  (Please indicate the number of each if you are bringing a guest)
       ___  Herb Stuffed Chicken Breast
___  Stuffed Flounder

Fees may be paid by check, payable to WVAGT (no purchase orders please)
Mail to:        Melinda Edwards, Treasurer
               1260 Kings Road
               Morgantown, WV 26508

Registration Deadline Information

Registrations to include meals MUST BE RECEIVED by October 1, 2010.  Meals cannot be guaranteed for late or
on-site registrations.

Please contact Patti Coon at padc78@hotmail.com or (304) 594-1043 if you need additional information.





WVGifted