NEW JERSEY MOSQUITO CONTROL ASSOCIATION ANNUAL MEETING

and Professional Training and Pesticide Recertification Credits

March 14th - 17th, 2006

REGISTRATION FORM  

ELECTRONIC REGISTRATION ENDS March 9th, 2006 at 4 pm EST

Resorts Atlantic City, Atlantic City, NJ  

Name:  
Companion:
Sharing a room with: 
Affiliation:
Street Address:  
City, State, Zip:  
Telephone Number:  
Email Address:

Registration Fee Schedule (Postmark Date) and Registration Type

(Select One Date)

On or Before 28 Feb

After 28 Feb

Full Registration (Meeting, Banquet and Receptions)

$ 150

$ 160

Meeting Only (No Banquet/Receptions)

$ 65

$ 70

Banquet Only (No Meeting/Receptions)

$ 60

$ 65

Student (3-Day Meeting only) or 1-Day Meeting Fee

$ 50

$ 50

Companion (Banquet & Receptions Only)

$ 75

$ 80

ELECTRONIC REGISTRATION ENDS March 9th, 2006 at 4 pm EST

Badge Preparation

Full Registration

Meeting Only

Banquet

Name:

Companion:
Affiliation:

Subtotal

 $ $ $

 

 

 Total To Be Paid at Final Registration: $

Method:

PO/Check #:

Make checks payable to: New Jersey Mosquito Control Association, Inc.

Mail to: Cape May County Mosquito Commission, P.O. Box 66, Cape May Court House, NJ 08210

 

For questions or information please contact the Cape May County Mosquito Control, Dr. Peter Bosak, Director at 609-465-9038 or by email: mailto:entoman60@hotmail.com