Print this form, fill out and mail or fax to the address listed at the bottom.
International Wheat Quality Conference
May 18-22, 1997
Holiday Inn - Holidome
Manhattan, Kansas, USA
Please print in ink or type:
_________________________________ _______________________________ ___________
Last Name(Mr./Ms./Dr.) First Name Initial
_______________________________________________________________________________
Affiliation/Job Title
_______________________________________________________________________________
Address
___________________ _____________________ __________ ________________
City State/Province Country Zip/Postal Code
___________________ ___________________________ __________________________
Phone Number* Fax Number* E-Mail
*Please include country and city codes for outside the North American Continent.
Guest Names*
___________________________________ __________________________ _____________
Last Name First Name Initial
*Guest Registration is free of charge. If guests want to attend social functions,
tickets should be purchased.
Names for Badge
____________________________________ _________________________________________
Registrant Guest
IN CASE OF EMERGENCY, CONTACT:
____________________________________ _________________________________________
Name Telephone Number
[ ] Please indicate any health related dietary
requirements/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.
TOURS: Plan to participate:
Yes No
Grain Science Dept., KSU Thursday, May 22, 1:30 p.m. Number_____ _____
American Institute of Baking Thursday, May 22, 2:45 p.m. Number_____ _____
USGMRL, USDA-ARS Thursday, May 22, 4:00 p.m. Number_____ _____
Registration Fees and Functions
Professional Date of Receipt U.S. Dollars Total
I. Early Bird: before February 7, 1997 $250.00 __________
II. Preregistration: before March 7, 1997 $350.00 __________
III. Regular: after March 7, 1997 $400.00 __________
Student**
I. Early Bird: before February 7, 1997 $ 50.00 __________
II. Preregistration: before March 7, 1997 $ 65.00 __________
III. Regular: after March 7, 1997 $ 75.00 __________
Full Registration Fee includes these functions: Do You Plan to Attend?
Yes No
1 Welcome Reception, Buffet Dinner (May 18, evening) ___ ___
1 Tour and Barbeque Dinner (May 19, evening) ___ ___
1 American Barn Dance and Dinner (May 20, evening) ___ ___
1 Banquet (May 21, evening) ___ ___
3 Lunches (May 19, 20, 21) ___ ___
7 Breaks (Coffee, Tea, Soft Drinks)
1 Conference Proceedings (Full Papers of Oral Presentations and
Abstracts of Poster Presentations)
**Special Student Registration fees include most of the above functions,
but do NOT include the Banquet (May 21, evening) or Conference Proceedings.
Student fee discounts require Institutional or Advisor Signature for student
certification (sign below).
______________________________________________________________________________
Dept. Head/Advisor
For Special One/Two Day Registration, complete the following:
Option S M Tu W Th Date of Receipt Fee*** Total
=====================================================================
One day __ __ __ __ __ Before Mar. 7, 1997 $125.00
One day __ __ __ __ __ After Mar. 7, 1997 $150.00 $________
Two day __ __ __ __ __ Before Mar. 7, 1997 $250.00
Two day __ __ __ __ __ After Mar. 7, 1997 $300.00 $________
*** These fees include the corresponding daily breaks and lunches and one copy of
the Conference Proceedings, but do NOT include admission to any of the evening
functions. For admission, purchase a ticket below for the desired function.
Extra Guest Tickets/Proceedings
Day Function/Item Number Cost/person Total
Sunday: Welcome Reception-Dinner ______ $20.00 $______
Monday: Tour-Barbeque Dinner ______ $15.00 $______
Tuesday: American Barn Dance-Dinner ______ $20.00 $______
Wednesday: Banquet ______ $30.00 $______
Proceedings ______ $50.00 $______
SUB-TOTAL GUEST TICKETS/PROCEEDINGS $______
SUB-TOTAL REGISTRATON FEES $______
TOTAL SUBMITTED $______
Payment
PAYMENT MUST ACCOMPANY REGISTRATION FORM
Payment in U.S. funds only. Checks must be drawn on U.S. Bank.
[ ] Check No. Enclosed____________________ (Make payable to IWQC)
[ ] Charge my credit card
Name of Cardholder__________________________________________
[ ] VISA [ ] MasterCard [ ] Am. Express
13-16 digits 16 digits 15 digits
Card Number:
[ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Card Expiration Date _________
(mo/yr)
Signature__________________________________ Date__________
Refunds are available by written request before April 1, 1997.
A $50.00 handling charge will be assessed.
No refunds after April 1, 1997.
Advance registrants will receive confirmation within three weeks of
receipt of registration payment.
Mail or fax form and payment to: (do not e-mail form and payment) (only forms
with credit card information will be processed via fax) Last revision January
11, 1997 JSteele Ms. Sandra Mathewson GMPRC, USDA-ARS 1515 College Avenue
Manhattan, KS 66502 USA Voice: 913-776-2701 FAX: 913-776-2789 Inet: sandy@usgmrl.ksu.edu
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