Name:_________________________________________________________________

Position: _______________________________________________________________

Home Address:__________________________________________________________

School Address: _________________________________________________________

Home Phone: ____________________ Business Phone: ____________________

Fax: ___________________________ E-mail: ____________________________

Conference Registration Fees:
Member................................$125.00
Non-Member............................ 170.00
First Time New Member
...Registration + Year's Membership... 150.00
Regular Member dues:.................. 45.00
Retired/Student member dues........... 25.00

Meals and Entertainment
I will be joining you at Dallas Bar-B-Que
on Thursday night, 11/21/02. (pay for what you eat)
(Circle One)... Yes_____ No___ Number attending_____

I will be joining you at El Quijote
Restaurant on Friday night, 11/22/02
(Circle One)... Yes_____ No_____ Number attending_____

Membership Dues for 2002 __________
Conference Registration __________
Total Enclosed __________

Please make check payable to "SSLI" and send to:

Jeannie Schwartz, Executive Director
SSLI
19 Savage Street
Charleston, SC 29401
Phone: (843) 577-5351