Please print, complete and return this form for the

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Please print, complete and return this form for the Powered By Docstoc
					                                     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
                                             Fax 813-979-4908
  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

___________________________________________________________________________________________________________
Affiliation                                               City/State

Area of interest (1-2 words):____________________________________________________________________________________

Free spouse badge (upon request) to read:_________________________________________________________________________

REGISTRATION: Pre-registration must be received by Wednesday, July 10th.

Full/Sustaining Member
         Pre-registration (includes 1 luncheon ticket)                          $100     ______
         On-site registration (may include 1 luncheon ticket)                   $125     ______
Student
         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______
        Student       $20
        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               $