REGISTRATION FORM

16th Annual
Catholic Homeschool Conference & Curriculum Fair
April 17, 2010
Harrisburg, Pennsylvania

Father’s Full Name______________________________________

Mother’s Full Name_____________________________________

Street Address_________________________________________

City/State/Zip__________________________________________

Phone (______)__________-_____________________________

Cell phone  (______)__________-_________________________

E-mail _______________________________________________

County_______________________________________________

Diocese______________________________________________

Please note: Nursing babies attend free of charge.

We ARE/ARE NOT currently homeschooling. 

(Circle one)
If homeschooling, for how long?_____(1st, 2nd, 3rd year, etc.)
If you use a Catholic home study program, which one? 

_____________________________________________________
 ___for books only   ____for the full service

Name of clergy to attend:

_____________________________________________________
Please check if attending:
Father  _______     Mother _______	

Registration fees
if postmarked by 4/10/2010:
     $15 first family member . . . . . . . . . . . . . . . . . . . . . .$________
     $8 spouse or grandparent . . . . . . . . . . . .  . . . . . . . $________
     $8 per child . . .(put names on reverse). . . . . . . . . .$________
if postmarked after 4/10/2010 or at the door:
    $18 first family member . . . . . . . . . . . . . . . . . . . . . . $________
    $8 spouse or grandparent . . . . . . . . . . . . . . . . . . . . $________
    $10 per child . . (write names on reverse). . . . . . . . .$________

Please note: Nursing babies attend free of charge.

Newsletter  ($18/family/12 months) . . . . . . . . . . . . . . . $________

Current or new newsletter subscribers:
DEDUCT discount of $3 X  _____ (# of persons ) . . . . ($_______)

Clergy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   FREE
	
TOTAL ENCLOSED . . . . . . . . . . . . . . . . . . . . . . . . . . .$________	

Please contact us if you are willing to volunteer.

Please fill out the following ONLY if you are a current or new subscriber to the network’s newsletter:

May we give out the following information to other parents who want to locate families in your area?
	(circle all that apply)
Yes	No	Your name and address
Yes	No	Your name and phone number
Yes       No        Your name and e-mail address 

We   would___    would not___    like to be included in the e-Alert list.
We   are___    are not___    interested in the group discount with Home School Legal Defense Association. (To be included or remain in the group discount, you: may reside anywhere in Pennsylvania, must be a current subscriber to the newsletter, and at least one parent must be Catholic.)

Please make check payable to: “Catholic Homeschoolers of PA”

Mail your check and this registration form to:  Catholic Homeschoolers of PA, 
c/o Larry and Ellen Kramer, 101 South College Street, Myerstown, PA 17067

For questions:  call (717) 866-5425 or e-mail conference@catholichomeschoolpa.org

Permission is granted to copy this form and brochure on any color paper for your family and friends.

God bless your family and the remainder of your school year!