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:________________________________________________________________________
Spouse/Companion:
__________________________________________________
Sharing a room with:____________________________________________________________
Affiliation: _____________________________Telephone Number: (_______) _______________
Mailing Address:_______________________________________________________________
City, State, Zip_________________________________________________________________
Email Address: __________________________________
Check here if you are a Speaker: ___________________
Registration Fee Schedule (Postmark 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 |
PRE-REGISTRATION DEADLINE IS February 28th, 2006
|
Name(s) as it should appear on the badge: |
Full Registration |
Meeting Only |
Banquet |
|
(name) |
|
|
|
|
(affiliation) |
|
|
|
|
Subtotals: |
$ |
$ |
$ |
Total
Registration Paid: $__________________ (Purchase Order
#________/Check #________/Cash)
Make
checks payable to: New Jersey Mosquito Control Association, Inc.
Mail
to: Cape May County Department of Mosquito Control, P.O. Box 66, Cape May Court House, NJ
08210
For Questions or Information please contact Dr. Peter Bosak, Director of Cape May County Department of Mosquito Control by e-mail: entoman60@hotmail.com or by phone at 609-465-9038.