Registration

*Required Information

*First Name
Name Preferred If Different From Above
*Last Name
Birthdate: month/day(05/17)see note below
Job Title
Firm/Organization
*Street Address
Address (cont.)
*City
*State/Province
*Zip/Postal Code
Country
*Work Phone
*Above address is Work or Home? (Indicate)
FAX
*E-mail

Note: Birthdate (month and day only) is used as an identifier to distinguish between two people with the same name.

 

Late Fee Main Conference $495 (after December 11th)

Exhibitor Fee $600

FULL Pre-conference Boat Tour + Social/Dinner $95

FULL Pre-conference Social/Dinner Only $45

Post-conference LID Tour $55

Student Career Awareness Lunch (1/31/07, no charge)

 

 

*Method of payment:

 

Visa or MasterCard (please call 919-515-7154 with card information) 

I will mail in check, including a copy of this completed form 

Please invoice my company

Purchase Order No.

Make check(s) payable to:
North Carolina State University

Mail to:
Kathryn Murray
NCSU Soil Science Department
Campus Box 7643 - UFL
Raleigh, NC 27695-7643

Total Registration Fee:

Additional Comments: Add any comments or special needs here.