___ Check or money order enclosed, payable to Westar Institute
                      (U.S. dollars drawn on a U.S. bank only)

Please bill my  ___ Visa  ___ MasterCard  ___ Discover  ___ AmEx

Card Number                                    Security Code ______
     

Exp. Date             Signature                               

First Name___________________________________ Second Name*__________________________________
                                          (*member's spouse may register at the member price)

Address _______________________________________________________ City _______________________ 

State _______________ Zip __________  Day phone ____________________________________________

Refunds are available if requested in writing by February 19 minus a $40 administrative fee. No refunds will be given after that date.    

Mail to Westar Institute, Willamette University, 900 State Street, Salem, Oregon 97301