Registration Form: 16th Midwest Herpetological Symposium
_________________________________________________________________________________
2000 Midwest Herpetological Symposium & Sale October 13-15, 2000 Kansas City, Missouri
Name of First Attendee:_____________________________________________________
Address ______________________________________________________
City_________________________________State___________Zip__________________
Phone ______________FAX ________________E-Mail ________________________
Herpetological Organization Affiliation (if any): _______________________________
Names of other attendee(s): ____________________________________________
Special Needs (accessability or diet): ___________________________
________________________________________________________________________
Registration - Speakers Conference _______ X $50.00 = ________________
before Sept. 22, 2000
Registration - Speakers Conference _______ X $60.00 = ________________
after Sept. 22, 2000
Banquet _______ X $25.00 = ________________
before Sept. 22, 2000
Banquet _______ X $30.00 = ________________
after Sept. 22, 2000
TOTAL: _________________
NOTE: Speakers conference does NOT include the Banquet!
If you are a dry goods vendor, will you be setting up for all 3 days of the symposium?
(Friday night through Sunday afternoon) YES_______ NO________
List any Special Requests. _____________________________________
Return this form with payment to:
KCHS, P.O. Box 118, Liberty, MO 64069
NOTE: This is the correct address, don't send to Kansas City, MO!!! Due to the confusion, late fees will be waived!
You can pay with a credit card using Paypal. Click on the banner below to sign up!
The form still needs to be printed and mailed in!
