49th Annual Delaware Short Course
Registration Form
February 20th and 21st, 2008
REGISTRATION FORM for 49th Annual DPCA Short Course
--- Register your entire company… 1 form… 1 check! (see reverse) ---

NAME: ____________________________________________________________________
( First )                         ( Initial )                 ( Last )                         

Company Name: __________________________________________________________

Address: __________________________________________________________  

Phone: _______________________ Fax: ___________________ Email:__________________    

                                                                                       # Attendees                  Total

$125.00 Association Member                                      ________                $________   

$75 Each Additional Person                                        ________                 $________

$175.00 all non-Members                                             ________                 $________

$110.00 One day only (anyone)                                   ________                 $________

Lunch on Wednesday $17.00 (sit down)                     ________                $________  

Lunch on Thursday $17.00 (sit down)                         ________                 $________

Grand Total                                                                    ________                 $________  

(After February 1, 2008, add $10 per person to above total.)
--------------------------------------------------------------------------------
Make check payable to DELAWARE PEST CONTROL ASSOCIATION and mail to:
DPCA
P.O. Box 5406
Deptford, New Jersey  08096


(see reverse for additional attendee names)




           Additional Short Course Attendees at $75.00 Each

   NAME                                                                                 NAME    

1.__________________________________    11.__________________________________    

2.__________________________________    12.__________________________________    

3.__________________________________    13.__________________________________    

4.__________________________________    14.__________________________________    

5.__________________________________    15.__________________________________    

6.__________________________________    16.__________________________________    

7.__________________________________    17.__________________________________    

8.__________________________________    18.__________________________________    

9.__________________________________    19.__________________________________    

10._________________________________    20.__________________________________    

Total # above _____ x $75.00 = $________ Enter these totals on front of form






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