(please print clearly)
Name: __________________________________________________________
Address: ________________________________________________________
City: ______________________________ Zip: _______________________
Phone: ____________________________
E-mail: __________________________________________________________
Registration Cost
$95 for AEYC Members and non-members
Fees are non-refundable however someone may attend in your place if you are unable to attend.
Only checks or Money Orders will be accepted. No credit cards or purchase orders please.
Amount of payment enclosed ________________
Please mail form and payment to:
Kern Association for the Education of Young Children
P.O. Box 1801
Bakersfield, CA 93301
Questions? Call 661/636-4444