Please
type or print in black ink:
________________________________
____________________________ _________
Last Name(Mr./Ms./Dr.)
First Name
Initial
________________________________________________________________________
Affiliation/Job Title
________________________________________________________________________
Address
___________________
__________________ __________ ________________
City
State/Province Country
Zip/Postal Code
___________________
___________________ _____________________________
Phone Number1
Fax Number1
E-Mail
1 - Please
include country and city codes for outside the North American Continent.
Guest Names2
Names for Badge(s)
IN CASE OF EMERGENCY, CONTACT:
________________________
___________________________ _________________
Name
Location
Phone Number
[ ] Please
indicate any health related dietary requirements or
preferences:_____________________________________________________
[ ] If you
have specific needs or require special accommodations to
fully participate in this Conference, please check here. You will
be contacted by someone from the planning committee to discuss your
specific needs.
TOUR INTEREST: (Thursday,
p.m., May 24th) Plan
to participate:
Tour
Yes No
Grain Science Dept.,
KSU
Number ____ ____
American Institute
of Baking
Number ____ ____
USGMRL, USDA-ARS
Number ____ ____
REGISTRATION FEES AND FUNCTIONS:
Professional _ Date of Receipt U.S. Dollars Selection
I. Early Bird:
before January 15, 2001 $300.00
$________
II. Preregistration:
before February 15, 2001 $400.00
$________
III. Regular:
after February 15, 2001 $450.00
$________
Student3
I. Early Bird:
before January 15, 2001 $ 60.00
$________
II. Preregistration:
before February 15, 2001 $ 75.00
$________
III. Regular:
after February 15, 2001 $100.00
$________
FULL REGISTRATION FEE INCLUDES
THESE FUNCTIONS: Do you plan to attend?
Yes No
1 Welcome Reception, Buffet
Dinner (May 20, evening)
___ ___
1 Dinner (May 21, evening)
___ ___
1 Dinner (May 22, evening)
___ ___
1 Banquet (May 23, evening)
___ ___
3 Lunches (May 21, 22, 23)
___ ___
7 Breaks (Coffee, Tea, Soft
Drinks)
1 Conference Proceedings
(Full Papers of Oral Presentations and
Abstracts of Poster Presentations)
3 - Special
Student Registration fees include all of the above functions, except the
Banquet (May 23).
Student fee discounts require Institutional or Advisor signature below
for student certification.
__________________
____________________ _________________ ___________
Dept. Head/Advisor
(print and sign) Dept./Institution
mo/day/year
FOR SPECIAL ONE/TWO DAY REGISTRATION,
COMPLETE THE FOLLOWING:
Option
S M Tu W Th Date
of Receipt Fee4
Selection
========================================================================
One day
__ __ __ __ __ Before Feb. 15, 2001 $150.00
One day
__ __ __ __ __ After Feb. 15, 2001
$180.00 $________
Two day
__ __ __ __ __ Before Feb. 15, 2001 $300.00
Two day
__ __ __ __ __ After Feb. 15, 2001
$360.00 $________
SUB-TOTAL IWQC-II REGISTRATION FEES $________
4 -
These fees include the corresponding daily breaks and lunches and one copy
of the
Conference Proceedings, but do NOT include admission to any evening function.
For these
registration fees, purchase a ticket below for the desired evening function.
EXTRA GUEST TICKETS AND PROCEEDINGS:
Day Function/Item Number Cost/person Total
Sunday
Welcome Reception-Dinner ______
$30.00 $________
Monday
Evening Dinner
______ $30.00 $________
Tuesday
Evening Dinner
______ $30.00 $________
Wednesday Banquet
______ $45.00 $________
Proceedings ______ $60.00 $________
SUB-TOTAL GUEST TICKETS AND PROCEEDINGS $________
M & B DIVISION LUNCHEON AND GOLF SIGN-UP:
IWQC-II
M&B Division Golfing
Luncheon Golfing Fee
Registrant Name
Member(yes/no) Nickname US $25
US $95
__________________
______________ ___________ $__________ $__________
__________________
______________ ___________ $__________ $__________
SUB-TOTAL M & B DIV. LUNCH AND GOLFING FEES $__________
PAYMENT
PAYMENT MUST ACCOMPANY REGISTRATION
FORM
Payment in U.S. funds only.
Checks must be drawn on a U.S. Bank.
Payment recap: SUB-TOTAL
IWQC-II REGISTRATION FEE ............. $_______
SUB-TOTAL EXTRA GUEST TICKETS AND PROCEEDINGS .. $_______
SUB-TOTAL M & B Div. LUNCH AND GOLFING FEES .... $_______5
TOTAL SUBMITTED .. $_______
[ ] Check No. ________ enclosed (Make payable to IWQC-II)
or charge my credit card: [ ] Master Card [ ] Visa Card
Name of Cardholder
___________________________Expiration Date _________
(mo/year)
Card Number:
[ ][ ][ ][ ][ ][ ][ ][
][ ][ ][ ][ ][ ][ ][ ][
]
1 2 3 4 5 6
7 8 9 10 11 12 13
14 15 16
Signature_______________________________ Date___/___/_____
(mo/day/year)
5 -
See AACC Milling and Baking Division Meeting announcement at end of IWQC-II
Program.
Advance registrants will receive
confirmation within three weeks of receipt of registration payment. No
refunds after March 30, 2001. Refunds are available by
written request before March
30, 2001. A $50.00 refund handling charge will be assessed.
Mail or fax form and payment
to: Ms. Marsha Grunewald
GMPRC, USDA-ARS
1515 College Avenue
Manhattan, KS 66502, USA
FAX: 785-537-5534
Do not E-Mail form and payment, only forms with credit card information will be processed via fax.
For further registration or
IWQC-II information, contact: Ms. Marsha Grunewald,
Ph: 785-776-2757, E-Mail:
Marsha
Grunewald <marsha@usgmrl.ksu.edu>