Please complete and return this form for the July 29-31 2002
Annual Meeting (and/or Workshop) to:
Business Manager, Florida Entomological Society
P.O. Box 1007, Lutz, FL 33548-1206
Save $25.00 PRE-REGISTER BY Wednesday JULY 10 (Payment may be made at the meeting). IT WILL SAVE MUCH
TIME AND CONFUSION AT THE MEETING. NOTICE: On-site registration may not be guaranteed a luncheon ticket!
All members must wear lapel badges to be admitted to program sessions!
Badge to read:_______________________________________________________________________________________________
First name Last name
Area of interest (1-2 words):____________________________________________________________________________________
Free spouse badge (upon request) to read:_________________________________________________________________________
REGISTRATION: Pre-registration must be received by Wednesday, July 10th.
Pre-registration (includes 1 luncheon ticket) $100 ______
On-site registration (may include 1 luncheon ticket) $125 ______
Pre-registration (includes 1 luncheon ticket) $30 ______
On-site registration (may include 1 luncheon ticket) $30 ______
Honorary or Emeritus (must purchase luncheon ticket) ______
Additional Awards Luncheon Tickets: # of tickets x $30 = ______
Workshop, Tuesday morning $35 ______
I will need a copy of the program in my registration packet. Yes No______
Do you plan to attend the awards luncheon on Tuesday, July 30? Yes No______
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
Annual dues for 2003* Are you currently a member of the Florida
Regular $40 Entomological Society? Yes No______
Sustaining $65 VISA AND MASTERCARD ACCEPTED
Donations** $ Card #_____________________________________
Total $ Signature___________________________________
* New members please give full mailing address, telephone, fax and email.
**Donations are tax deductible. Donations can be unrestricted, or designated to specific causes such as student travel or awards.
IF A RECEIPT IS NEEDED, PLEASE COMPLETE FORM BELOW (receipts will be available at registration desk):
Received from: $___________________________
Registration: Annual dues for 2003:
Pre-registration $100 Regular $40
On-site registration $125 Student $20
Student $30 Sustaining $65
Workshop $35 Donations $
Additional awards banquet tickets: x $30 = ________ $
Received by: Total $