Sample Registration Form
Potato Association of America
92nd Annual Meeting
August 10 to 14, 2008 – Adam’s Mark Buffalo-Niagara Hotel – Buffalo, NY
REGISTRATION FORM
Registration |
Your registration is not valid until payment is received:
Three Ways to Register 1) Register On-Line 3) Register by Mail (mail completed form & payment) https://www.hort.cornell.edu/PAA2008/ Sue Thompson 15 A Plant Science Building 2) Register by FAX Department of Horticulture Complete this form and fax to: 607-255-0599 Cornell University Ithaca, NY 14853 |
Delegate Information |
Preferred name, full name and affiliation will appear on name badge. Print legibly or type. |
Designation:
¨ Prof. ¨ Dr. ¨ Student ¨ Other _________________ PAA or EAPR Membership # _________________ |
Name: _______________________________________________________________________ First Name MI Last Name (Surname)
_______________________________________________________________________ Registrant’s preferred first name for badge
Institution/ Affiliation: ___________________________________________________________
|
Student Verification |
I verify that the person whose name appears on this registration form is a student.
____________________________________ ________________________________________ Advisor’s Signature Print Name Accompanying Persons Information |
Accompanying Persons Information |
Name: _______________________________________________________________________ First Name MI Last Name (Surname)
_______________________________________________________________________ Registrant’s preferred first name for badge
|
Delegate Mailing Address |
Address: ___________________________________________________________________ Street Address
___________________________________________________________________ City State Zip Code Country
Phone: __(______)__________________________ Fax: __(_____)____________________ Please include area, city and country codes Please include area, city and country codes
E-mail: _______________________________________________________________________ Required for confirmation purposes, participation roster and receipt. If an e-mail address is not provided the above information will be sent via regular mail |
Registration Fees | ||||
# of
Attendees |
Payment before
July 15 |
Payment
After July 15 |
Total $ |
|
PAA – EAPR Member Registration | . | ¨ $275 | ¨ $375 |
.00 |
Non-Member Registration
To save non-membership fees, please join the PAA now ($100) by going to PAA website: https://www.umaine.edu/paa/mbrappl.htm |
. |
¨ $375 | ¨ $475 |
.00 |
Student Registration Requires advisor signature (see student verification) | . | ¨ $140 | ¨ $190 |
.00 |
Accompanying Persons Registration Fee includes 4 breakfast buffets, 3 lunches and Welcome Reception | .
|
¨ $75 each | ¨ $100 each |
.00 |
Golf Scramble – Sunday August 10 | . | ¨ $45 each | ¨ $45 each |
.00 |
Henry De Jong Sponsorship Bike Ride (and challenge from Larry Hiller) for the PAA Endowment Fund (US tax deductible donation) | — |
.00 |
||
Industry Program –Tuesday August 12 – Fee includes break and lunch | . | ¨ $30 each | ¨ $30 each |
.00 |
Wine and Cheese Social (plus Live Auction and Variety Show) – Tuesday August 12 No fee, but please let us know you are coming! |
# of Attending____________ |
.00 | ||
Agriculture Tour – Wednesday August 13 | . | ¨ $40 each | ¨ $55 each |
.00 |
Optional PAA-sponsored (5) tours with Gray Line
Please mail or fax your selections to Gray Line. Use separate enclosed Gray Line Bus Form. |
.00 | |||
BBQ – Taste of Buffalo – Wednesday August 13 | . | ¨ $25 each | ¨ $35 each |
.00 |
Awards Banquet – Thursday August 14
Note: free banquet ticket for graduate students in awards competition |
. | ¨ $35 each | ¨ $45 each |
.00 |
. | Registration Total | $ | ||
Conference Questions | ||||
1. Do you have any special dietary needs? [ ] Yes [ ] No
Explain_______________________________________________________________________________ 2. Do you have any other special needs? [ ] Yes [ ] No Explain_______________________________________________________________________________ |
||||
Cancellation Policy | ||||
All cancellations must be received before Monday, August 4, 2008. Cancellations are processed as soon as possible less cancellation fees listed below.
Member Registration: $55 Non-member Registration: $55 Student Registration $45 Accompanying person’s registration: $20 Industry Program $10 Optional on-site event selections 25% |
||||
Registration Submission | ||||
Submit your registration form online at https://www.hort.cornell.edu/PAA2008/ or send a copy by fax (attn: Sue Thompson) at (607)255-0599 or regular mail to: Sue Thompson, 15A Plant Science Building, Department of Horticulture, Cornell University, Ithaca, NY 14853 | ||||
Payment Information | ||||
Enclosed is my check (must be in U.S. dollars from a U.S. bank) or a money order made payable to Cornell University or charge my credit card account as follows:
[ ] VISA [ ] MasterCard [ ] American Express [ ] Discover Credit Card Number: ___________________________Expiration Date_______________ CCV# ____________
Name of Card Holder: __________________________________________________________________ (as it appears on card) Signature_____________________________________________________________________________ Total Amount Due: $______________ *Registration Form will not be processed without the signature of the cardholder. ** The CCV (Credit Card Validation) number is a 3 digit code printed on the BACK of your card in the signature panel. For American Express it’s four numbers on the front of the card. |
||||
Registration Confirmation | ||||
Once your registration form has been processed, you will receive confirmation by e-mail. If an e-mail address is not provided the confirmation will be sent via regular mail. This confirmation will include a receipt. If you have not received this correspondence in ten (10) business days after submitting your registration form, please contact Sue Thompson at 607-255-7889 or [email protected] to inquire whether your completed registration form was received. | ||||
Questions | ||||
Please call Don Halseth at 607-255-5460, [email protected] or Joe Sieczka at 631-298-4423, [email protected]. |