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____ Annual Meeting
The Potato Association of America
(Month day-month day, 20__)
(Institution name)
City, State/Providence
Advance Registration Deadline—Date
Name:____________________________________________________________________________________________
(last)
(first)
(mi)
Address:
__________________________________________________________________________________________
City:______________________________________________
State/Province_________________________________
Country___________________________________________
Postal Code___________________________________
Telephone: (Home)
__________________________________
(Office)_______________________________________
Name of
spouse/guest_______________________________________________________________________________
Names of
children__________________________________________________________________________________
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Registration
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Advance
|
Late
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Total
|
|
PAA Member
|
$ ________________
|
$ ________________
|
$ ________________
|
|
Non-Member
|
$ ________________
|
$ ________________
|
$ ________________
|
|
Student
|
$ ________________
|
$ ________________
|
$ ________________
|
|
Spouse/Guest
|
$ ________________
|
$ ________________
|
$ ________________
|
| |
|
Total
Meeting Reg:
|
$ ________________
|
| |
|
|
|
Special Events
|
Quantity
|
Cost
|
Total
|
|
Pre-Meeting Tour
|
__________________
|
$ ________________
|
$ ________________
|
|
President's Reception
|
__________________
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N/C (need count)
|
_________________
|
|
Wednesday Barbecue
|
__________________
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may or may not charge
|
$ ________________
|
|
Wednesday's Tour A
|
__________________
|
$ ________________
|
$ ________________
|
|
Wednesday's Tour B
|
__________________
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$ ________________
|
$ ________________
|
|
Wednesday's Tour C
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__________________
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$ ________________
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$ ________________
|
| |
Total Special Events Registration:
|
$ ________________
|
| |
|
|
|
|
Spouse/Guest Events
|
Quantity
|
Cost
|
Total
|
|
Name of Tour
|
__________________
|
$ ________________
|
$ ________________
|
|
Name of Event
|
__________________
|
$ ________________
|
$ ________________
|
| |
Total Spouse/Guest Events Registration: |
$ ________________
|
| |
|
|
|
| |
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Total Registration:
|
$ ________________
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Childcare
requirements: Date(s)
Names and ages:
1.
___________________________________________________________________________________
2.
___________________________________________________________________________________
3.
___________________________________________________________________________________
If traveling by air, please indicate:
Airport _________________________________
Airline:_______________________________________
Arrival date:_____________________________ Arrival time:
___________________________________
Return to: PAA Conference
Facility name
Facility address
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