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. (Over) 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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