2003 AZA WESTERN
WORKSHOP REGISTRATION FORM
May 14th-17th,
2003 v Calgary, Alberta
Name: ____________________________________ Institution: _________________________
Title:
_____________________________ Department:
_______________________________
Mailing
Address: ________________________________________________________________
City:
___________________________ State:
_________________ Zip Code:
_____________
Phone:
(_________) _______________________
Fax:: (_________) _____________________
E-Mail:
_______________________________________________________________________
o
Indiv. Member (#_____) o Member’s Spouse
o
Non-Member Speaker o Non-Member
o
Student
|
Full
Registration Fees: |
|
Daily
Registration Fees: |
|
Events
& Activities: |
|
Full registration includes all sessions and conference social events [ ]
Individual Member - $175 [ ]
Member’s Spouse - $175 [ ]
Non-Member Speaker - $175 [ ]
Non-Member - $250 [ ]
Student (with I.D.) - $75 [ ]
International Colleague - $175
(except Canada) If
received after Friday, April 11, 2003: [
] $20 Late Fee Applies Full registration does NOT include pre and post conference activities |
Date attending: [
] Thu. [
] Fri.
[ ] Sat. If
received before Frida [ ]
Individual Member - $75 [ ]
Member’s Spouse - $75 [ ]
Non-Member Speaker - $75 [ ]
Non-Member - $100 [ ]
Student (with I.D.) - $30 [ ]
International Colleague - $75
(except Canada) If
received after Friday, April 11, 2003: [
] $10 Late Fee Applies Social events NOT included with daily registration |
[ ]
Icebreaker (May 14) - $20 [ ]
Zoo Day (May 16) (includes
admission, transportation,
lunch, and banquet) - $40 [ ]
Pre-conference day trip to
Royal Tyrrell Museum of
Paleontology (May 13)
(admission, transp.) - $35 [ ]
Post-conference day trip to
Banff (May 18) Visit to Cave & Basin,
transportation, Hot springs) - $50 |
||
|
Subtotal
of above: $_______ |
Subtotal
of above: $________ |
Subtotal
of above: $_______ |
||
Grand Total: $_____________ALL
ABOVE FEES ARE IN U.S. DOLLARS
|
||||
Sorry, but fees are not refundable after April 30th, 2003. Requests
for refunds must be made in writing.
Registrations will not be accepted after Wednesday, May 7th, 2003.
o Please check here if you
would like a vegetarian meal at the banquet
Paying
by credit card? Please provide:
Name on Credit Card: ______________________________________________________ (please print) Credit Card Number: ________________________________________ Expiry Date: _____ /_____ Signature of Registered
Cardholder: _____________________________________________________ Then
fax this document to Alanna Loftus at (403) 237-7582, or mail to the
address below |
Paying
by cheque or money order?
Make
payable to Calgary Zoological Society, then mail completed form and
payment to:
Calgary Zoo, Attention Alanna Loftus, 1300 Zoo Road N.E., Calgary,
Alberta, Canada T2E 7V6 |
