Conchologistsofamerica.org



2021 Conchologists of America Convention _______ Melbourne, Florida Office Use Only: June 14-15 Field Trips, June 16-18 Programs, Bourse June 19-20 Check No ________ Name: ________________________________________ Spouse: ___________________________________________________ Print Name for Name Tags: ________________________________________________________________________________ Mailing address: Street: _____________________________________ City: _________________________________________ State: ________________________________ Zip: ______________ Country: ______________________ Email address: ___________________________________________ Phone: ____________________________________________ Home Club: ________________________________________ First time attending COA YES: _______ Registration FeesNo. of PersonsEarly Registration -included Banquet & Welcome Party ______ @ $195 per person $ ____________Full Registration (Postmarked after May 13) ________ @$225 per person $ ____________Guests attending Welcome Party ________ @$50 per person $____________Guests attending the Banquet: ________ @$50 per person $____________ Print Name for Guest Name Tags: ______________________________________ City: _________________________________________ State: ________________________ Banquet Choices – indicate the number of each meal you are ordering A, Seared Red Snapper Filet ______ B. Grilled Pork Chop ________ C. Vegetarian: Joseph Mushroom Ravioli_____ Lemon Tomato Caponata with Apple & Raisin Chutney with Pesto Cream SauceClub Representative to COA? Will you attend the COA club rep breakfast on June 19? Yes: __ (one rep per club) Do you require a Club table? Yes ___Field Trips & Tours Attach completed Field Trip Tour form to Convention Registration: $_____________Dealer’s Bourse Attach complete Bourse Agreement to Convention Registration form: $_____________ $40 per DAY PER assistant – charge waived for Bourse Assistants who are registrants of the convention. Convention Boosters (Donations received by May 1 listed in Convention Program Guide)Aplysia $25-$249 _______ Angel Wing $250-$499 _______ Astronaut $500+ _______ $_______________ GRAND TOTAL: $_______________Payment Checks on U.S. bank only, make payable to “COA 2021” SEND FORMS & PAYMENT to COA2021, PO Box 540746, Merritt Island, FL 32954 U.S.Payment: Payment for convention & bourse may be made by PayPal? to: billing@ Be sure to enter your name and purpose of your payment in the message window. Forms must be mailed to Marsh Kirtley or scanned and sent to: MarshaK07@. Include a copy of your acknowledgement from PAYPAL? that payment has been made. REMEMBER to sign your name before scanning.AUCTION DONATIONS to Dave Green, 3522 Bassett Court, Missouri City, TX 77459-6442 dgreen2@entouch,comRegistrar: Marsha Kirtley MarshaK07@. Assistant Registrar: Alan Gettleman lychee@cfl. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download