FIAR National Conference
October 8-10, 2004 
A Weekend In The Woods
Registration Form

Thank you for your interest in the tenth annual Five in a Row
National Conference.  To register, print this form, fill it out,
and mail it with your check or money order to the address listed
on the bottom.  All prices are in U.S. Dollars.


   Name:    ___________________________________________

   Address: ___________________________________________

   City/State/Zip: ____________________________________

   Daytime Phone: _____________________________________

   Evening Phone: _____________________________________

   E-mail Address: ____________________________________

   Credit Card Number: ________________________________

   Visa __ or Mastercard __ or Discover___ Expiration Date: __________

 You may pay for the retreat in its entirety and receive $10 in "Bonus Bucks" for use at the
 retreat on any Five in a Row product, or you may just send $95.00 Registration Fee to 
 guarantee your spot. All balances must be paid in full no later than 7/31/04, however, and 
 the $95 registration fee is non-refundable. 


     ___ Myself
         $195 ($220 after 08/01/04)
         

     ___ Myself and my Nursing Infant
         $195 ($220 after 08/01/04)
         I understand I'll be in the Wee Ones Cabin with other moms and infants.

     ___ Myself and my Husband
         $395 ($420 after 08/01/04)
         We would like our own private room.

     ___ Myself and my Family
         $595 ($620 after 08/01/04)
         I understand I will be attending the meetings while my husband watches the children.


     
     I have enclosed: ____________

     I understand my balance is: ____________
                          and is due no later than 7/31/04.


   Please remember-no children other than nursing infants
   under 12-months of age will be allowed at the retreat!

Make Check or Money Order Payable To:
          Five In a Row Publishing
          P.O. Box 707
          Grandview, MO 64030-0707


              Thank you for registering!

If you have any questions, please get in touch with us at:
Phone: (816) 246-9252
Fax: (816) 246-9253
Email: lambert@fiveinarow.com