LYCEUM REGISTRATION 2012
Time to Align
MAY 24-26, 2012
Sherman College Privacy Policy
CONTACT INFORMATION Discount applied for advanced registration until 5/11
	First name	Last name	Suffix
	Mailing address
	City	State/Province	Country	Zip
	Daytime telephone	Fax number	Email address
	College Sherman College Alumni please check this box		Graduation Year (####)
Fields in red are required and if not supplied will prevent the registration from being processed
RIBBONS (Check all that apply to primary registrant)
	ADIO/PCSC		Faculty
	Alumni Association Member		IFCO
	ACP		WCCS
	Board of Trustee		DC2B
	Chiropractic Student (non-Sherman)		ROAR
	Doctor of Chiropractic
	Class Reunion	Indicate Year 1977 1982 1987 1992 1997 2002 2007
	* Regents - please contact Missy Sandor (800)849-8771 ext. 229 or msandor@sherman.edu to register
PRIMARY REGISTRATION
	Pricing categories    Choose a category which best describes you DOCTOR OF CHIROPRACTIC $360.00 REUNION YEAR D.C. $195.00 RETIRED D.C. $195.00 D.C. ONE DAY ONLY $195.00 SECOND YEAR SHERMAN GRADUATE (6/2010 - 4/2011) $195.00 FIRST YEAR SHERMAN GRADUATE (6/2011 - 4/2012) $0.00 CHIROPRACTIC ASSISTANT $125.00 CHIROPRACTIC STUDENT (NOT SHERMAN) $60.00
GUESTS and CHILDREN'S PROGRAM
	Enter the total number of Guests $60.00 per person (includes spouse and must be non-D.C.)
	Children are not charged a registration fee and should not be included as a guest (above). The quantities below should only be indicated if you wish to have a child in our daycare program
	Childrens program all three days (day care). 1st child $80.00 each additional child $20.00.
	Childrens program one day only $30.00 per day per child
	Total child care			0.00
	5K Run
	GOLFTournament
	Guest First Name	Guest Last Name	Guest or Child
			Guest Child	5K Golf
			Guest Child	5K Golf
			Guest Child	5K Golf
			Guest Child	5K Golf
EVENTS
	EXTRA! EXTRA!
	Banquet Pricing!! $25.00 per person. Banquet tickets available until Friday, 5/25
	Alumni Association Luncheon
	Member	Complimentary
	Guests	$12.00 per person
	Alumni Reunion Reception
	Class Reunion Alumni	$25.00
	Guests	$25.00 per person
	Reunion Alumni YES NO Please indicate whether we have your permission to publish your name on the reunion page of the alumni website
	ALL INFORMATION WILL BE VERIFIED AND YOU WILL BE CONTACTED REGARDING ANY DISCREPANCIES
	Clicking submit will take you to a secure page. Your credit card will be charged:			$0.00
	Prior to proceeding to the payment page it is highly recommended that you click update to review your correct total