2012 SEMINAR REGISTRATION FORM

                            CONEJO VALLEY GENEALOGICAL SOCIETY

                                    Featured Speaker:
                               John Philip Colletta, Ph.D.


                      Saturday, March 24, 2012, 8:30 AM – 3:30 PM


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 Name(s) as you want them on name tag(s)

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 Address                                        City, State ZIP

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 Phone Number                                   Email address

 Handicapped seating needed (specify number)? ________

 CVGS Members (received or postmarked by Feb. 29, 2012)..... ____ @ $35.00 ___________
 Non-Members (received or postmarked by Feb. 29, 2012)...... ____ @ $40.00 ___________
 Late Registration (received/postmarked after Feb 29, 2012)..____ @ $45.00 ___________
 Tasty Box Lunch available:       Total number of lunches... ____ @  $8.50 ___________
     Indicate number: Beef ____  Turkey ____  Cheese ____
     (served with: pasta salad, coleslaw, fruit, and cookie)
                                                          TOTAL ENCLOSED  $___________

 Please mail registration form and check payable to CVGS to:
    CVGS c/o
    2482 Oakshore Dr.
    Westlake Village, CA 91361

 For questions, email: cvgs2012seminar@aol.com