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1999 Illinois Crop Protection Technology Conference Preregistration Form

November 6, 1998
UFAS ACCT# 1-3-64014-0660 FEIN# 37-6000511-Rev.'99 Crop Tech.



Conference Dates: January 6 and 7, 1999

Location: University of Illinois, Illini Union, Urbana, Illinois



Please mail completed preregistration form(s), or fax to (217)333-9561, by December 18, 1998. Call (217)333-2881 to register by phone. On-line registration is possible through the World Wide Web a (http://www.conted.uiuc.edu/ci/icptc).



Name



Social Security #



Federal legislation may make it possible for participants in certain educational programs to qualify for lifelong-learning income tax credit(s). To receive a statement from the University of Illinois, you must provide your social security number. Providing this information is voluntary, and it will be used only for tax-reporting purposes.



Company/Business



Address





City/State/Zip Code



County



Telephone (business)



Telephone (home)


Method of Payment




____Check enclosed (made payable to the University of Illinois)

____I prefer to charge on credit card:








VISA MasterCard
American ExpressDiscover
Card No.Card No.
Expiration DateExpiration Date



Signature of card holder:




Preregistration: $80 per person (includes one copy each of the 1999 Proceedings of the Crop Protection Technology Conference and the 1999 Illinois Agricultural Pest Management Handbook.) Walk-in registration is $95.



NOTE: If paying for more than one person, please enclose a completed preregistration form for each person (one check may be written to cover the total payment).



Mail completed preregistration form(s) along with payment to



University of Illinois at Urbana-Champaign

Cashiering Office

Administration Building Room 162

506 South Wright Street

Urbana, IL 61801


Author: Mike Gray