72nd Convention Registration Form by nuhman10

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									                                              72nd ANNUAL MEETING

                                 LOUISIANA WILDLIFE FEDERATION, INC.

                                 Alexander Fulton Hotel – Alexandria, Louisiana
                                              March 18-20, 2011

Name______________________________________________Email____________________________________

Address_________________________________________________________Phone_______________________

Town_______________________________________State______________________Zip___________________

Club Affiliation (if any)________________________________________________________________________

Circle pertinent designations - I am a:
 voting delegate;      LWF director;      LWF past president;       affiliate club member;     contributing member;

Other organization/agency affiliation you wish to have included on your name tag___________________________


                                          Preregistration and Ticket Order

Quantity                                                                                           Remittance

________         *Registration Fee $15 if preregistering by March 12th, otherwise $20        _____________________

________         Tour/Lunch (for spouses and other guests) – $35                             _____________________
                 (includes registration, and hospitality event discount)

________         Friday Evening Fish Fry and Auction – $20 for registered guests,            _____________________
                 otherwise $25

________         Board Luncheon at $20 ea.                                                   _____________________

________         Board Breakfast at $15 ea.                                                  _____________________

________         Reception and Awards Banquet at $40 ea.                                     _____________________

                                                                      Total Remitted:        _____________________

I am paying by: check ____ credit card _____       (Please provide credit card information on back of this page.)

* If you are paying for registration or event fees for individuals other than yourself, please indicate on the back of
this form the name of each such person so we can prepare proper name tags. Thank You!

Reply to: Louisiana Wildlife Federation, P.O. Box 65239, Baton Rouge, LA 70896-5239 prior to March 12th.


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72nd Convention Registration, Page 2


I am paying the registration fee/event ticket fee(s) for the following additional person(s):

                 Name                                     Event                                Fee

(1) ____________________________________________________________________________________

(2) ____________________________________________________________________________________

(3) ____________________________________________________________________________________

(4) ____________________________________________________________________________________



Credit Card Information

I wish to pay convention registration and function ticket fees with a credit card. (Only MasterCard and VISA
accepted)

_____ VISA or _____ MasterCard

Card Number: __________________________________________ Exp. Date ______________


Signature: ______________________________________




If you wish to be a convention sponsor, you may include your contribution with this registration form and mail it
to the LWF office, or you may call or email in your credit card information. Be sure to designate the sponsorship
category. The Louisiana Wildlife Federation is a qualified, tax-exempt, charitable organization under Section
501(c)(3) of the Internal Revenue Code and therefore the value of any donation you make to LWF is tax-deductible
to the extent allowed by law for charitable contributions. We will acknowledge donors in the printed convention
program in these giving categories:

                                           Corporate Eagle: $1,001 - 5,000
                                                Eagle: $501 - $1,000
                                               Whitetail: $251 - $500
                                              Wild turkey: $101 - $250
                                            Largemouth Bass: $51 - $100
                                                 Sunfish: $35 - $50

Donors will be recognized at the fundraising auction and dinner on Friday evening at which we hope you will be
our guest.

								
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