Potato Association of America

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 sdt1@cornell.edu to inquire whether your completed registration form was received.
Questions
Please call Don Halseth at 607-255-5460,  deh3@cornell.edu or Joe Sieczka at 631-298-4423,   jbs5@cornell.edu.

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