Please print, complete and return this form for the July 28-30,
2003 Annual Meeting (and/or Workshops*) to:
Business Manager, Florida Entomological Society
P.O. Box 1007, Lutz, FL 33548-1007
Fax 813-979-4908
Save $25.00! PRE-REGISTER BY MONDAY, JULY 7 (Payment may be made at the meeting).
NOTICE: On-site registration may not be guaranteed a luncheon ticket!
All members must wear lapel badges to be admitted to program sessions
Badge to read: _________________________________________________________
                                                                                        First name                                                             Last name
Affiliation ________________________________ City/State _________________________

Area of interest (1-2 words):  _____________  Free spouse badge (upon request) to read: _______________

REGISTRATION: Pre-registration must be received by Monday, July 7, 2003.

Full/Sustaining Member Pre-registration (includes luncheon ticket, Workshops) $100 ______
On-site registration (luncheon ticket when available) $125  ______
Student  Registration (includes luncheon ticket if preregistered)  $30 ______
Honorary or Emeritus (must purchase luncheon ticket)  -- ______
Additional Awards Luncheon Tickets:      # of tickets _____ x $30 = $ ______
*Wood Dest. Org. Workshop (Tues.) Pre-registration recommended (space for only 45 registrants) $35  ______
*Education Workshop [Also complete Workshop Form] Pre-registration, $25, On-site registration $35 (includes lunch) ______
I need a copy of the program in my registration packet. Yes_  No_.   I will attend the awards luncheon, Tuesday, July 29. Yes _ No _.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 
Annual dues for 2004* Are you currently a member of the Florida Entomological Society?  Yes _  No _
Regular $40 ______
VISA AND MASTERCARD ACCEPTED
* New members please include mailing address: 
Student $20  ______
Card #__________________
___________________________________
Sustaining $65  ______
 Exp. date _______________
________________________
Donations**  $ ______
Signature________________
phone_______________, fax ___________
Total $ ______
email:______________________________
**Donations are tax deductible. Donations can be unrestricted, or designated to specific causes such as student travel or awards.
IF A RECEIPT IS NEEDED, PLEASE COMPLETE BELOW: (receipts will be available at registration desk):
Received from:___________________________________________  $____________      by:  _____________________
Registration: Annual dues for 2004:
Pre-registration $100 ______
Regular
 $40 ______
On-site registration $125 ______
Student 
 $20 ______
Student  $30 ______
Sustaining 
 $65 ______
Wood Dest. Organisms/Education  Workshop ($35/25) ______
Donations
 $ ______
 Additional awards banquet tickets _____ x $30 $ ______
Total
 $ ______