event registration - aiswcd.org · please check only one: regular-one-day! $25.00 (june 16-30,...
TRANSCRIPT
69th AISWCD Annual Meeting & IL Land and Water Resources
Training Conference
EARLY BIRD-One-Day! $20.00
(June 1-15, 2017) Check ONLY One: ______Monday _____Tuesday
One lunch is included in the one-day cost
EVENT REGISTRATION
________________________________________________________________________________________________
Name SWCD District Name or Affiliation
________________________________________________________________________________________________
Guest Name
________________________________________________________________________________________________
Mailing Address City State Zip
________________________________________________________________________________________________
Phone Number Payment Type
Please check ONLY one:
REGULAR-One-Day! $25.00
(June 16-30, 2017) Check ONLY One: _____Monday _____Tuesday
One lunch is included in the one-day cost
EARLY BIRD-Two-Day! $40.00
(June 1-15, 2017)
Two lunches are included in the two-day cost
ONE-DAY REGISTRATION TWO-DAY REGISTRATION
REGULAR-Two-Day! $45.00
(June 16-30, 2017)
Two lunches are included in the two-day cost
LATE-One-Day! $35.00
(July 1-14, 2017) Check ONLY One: _____Monday _____Tuesday
One lunch is included in the one-day cost
LATE-Two-Day! $55.00
(July 1-14, 2017)
Two lunches are included in the two-day cost
ATTENDEE INFORMATION
Check # _________
*Credit Card
Mail or Email registration form along with payment to: Coles County SWCD ATTN: Terina Coffey
6021 Development Dr. Suite 2 Charleston, IL 61920 [email protected]
Registrations will not be processed until payment is received Pay by check or credit card
EMAIL:_____________________________________
*For all Credit Cards, AISWCD will send a
PayPal invoice to your email listed above
Director
Associate Director
SWCD Employee
IDOA
IEPA
IDNR
NRCS
FSA
Award Winner
Other
1. Guests MUST be identified on the conference attendee’s registration form.
2. Lunches will be provided to all registered attendees and their guests, with paid registration.
3. In order to process your registration, payment must be included.
4. Full refunds will be made on advance payments for cancellations through July 14, 2017.
5. Absolutely NO registrations will be taken or refunds given after July 14, 2017.
6. If you miss the deadline to attend, you may pay at registration/check-in on the day of the confer-
ence at the Late Fee payment option only.
7. In order to receive a lunch, you MUST be wearing a conference name tag
69th AISWCD Annual Meeting & IL Land and Water Resources
Training Conference
EARLY BIRD-One-Day! $5.00
(June 1-15, 2017) Check ONLY One: ______Monday _____Tuesday
One lunch is included in the one-day cost
GUEST EVENT REGISTRATION
REGULAR-One-Day! $10.00
(June 16-June 30, 2017) Check ONLY One: _____Monday _____Tuesday
One lunch is included in the one-day cost
EARLY BIRD-Two-Day! $10.00
(June 1-15, 2017)
Two lunches are included in the two-day cost
ONE-DAY REGISTRATION TWO-DAY REGISTRATION
REGULAR-Two-Day! $15.00
(June 16-June 30, 2017)
Two lunches are included in the two-day cost
LATE-One-Day! $15.00
(July 1-14, 2017) Check ONLY One: _____Monday _____Tuesday
One lunch is included in the one-day cost
LATE-Two-Day! $20.00
(July 1-14, 2017)
Two lunches are included in the two-day cost
REGISTRATION FORM FAQs:
Page 2
Mail or Email registration form along with payment to: Coles County SWCD ATTN: Terina Coffey
6021 Development Dr. Suite 2, Charleston, IL 61920 [email protected]
Registrations will not be processed until payment is received Pay by check or credit card
69th AISWCD Annual Meeting & IL Land and Water Resources
Training Conference
EXTRAS
TOTALS
Monday Evening—BINGO CARDS Sunday Conservation Boat Tour
FARM FAMILY MEAL
YES—One Ticket at $35.00 (includes dinner)
YES—Two Tickets at $70.00 (includes dinner)
YES—One Package (5 games) at $20.00
YES—Two Packages (10 games) at $40.00
*Additional cards can be purchased at Registration
Page 3
Farm Family Banquet—Beef … $30.00
Roast Sirloin of Beef with Red Wine Sauce, Pearl Onions, Slivered Bacon, and Mushrooms
Farm Family Banquet—Chicken … $30.00
Bruschetta Chicken Breast Balsamic marinated Chicken Breast topped with Diced Tomatoes, Red Onion, Basil, Garlic, and Mozzarella Cheese
Farm Family Banquet—Beef … $30.00
Roast Sirloin of Beef with Red Wine Sauce, Pearl Onions, Slivered Bacon, and Mushrooms
Monday Evening—ATTENDEE Monday Evening—GUEST
Farm Family Banquet—Chicken … $30.00
Bruschetta Chicken Breast Balsamic marinated Chicken
Breast topped with Diced Tomatoes, Red Onion, Basil, Garlic,
and Mozzarella Cheese
Farm Family Banquet—Fish … $30.00
Encrusted with bread crumbs and parmesan cheese
Farm Family Banquet—Fish … $30.00
Encrusted with bread crumbs and parmesan cheese
I HAVE FOOD ALLERGIES. List dietary restrictions__________________________________________________________________
FOOD ALLERGIES
Totals from Page 1
$________________
Totals from Page 2
$________________
Totals from Page 3
$________________
GRAND TOTAL
$________________