PSIW 2001 - Registration Form

Please note that we currently do not accept online Registrations.
Please fill out and print this form and mail it to the address below.

Name:
Title:
Company:
Address:
City:
Prov/State:
Country:
Post/Zip Code:
Tel:
Fax:
Date:

$ 60.00 Per Person Prior to September 1, 2001
$ 80.00 Per Person After September 1, 2001, or At The Door

x $60.00 = $ Enclosed

x $80.00 = $ Enclosed

REGISTRATION, INCLUDING PAYMENT, SHOULD BE SUBMITTED BY SEPTEMBER 15, 2001

Make Cheque/Money Order Payable to: Poultry Service Industry Workshop

	Please indicate if you will attend the October 4^th banquet.
	Please indicate if a spouse/companion will accompany you to the banquet.

Mail to: Sandy Clarke
Alberta Agriculture, Food and Rural Development
#905 O.S. Longman Building
6909 - 116 Street
Edmonton AB T6H 4P2
Tel (780) 422-0508
Fax (780) 427-1439
E-mail: sandra.clarke@gov.ab.ca

Please Check One Primary Occupation
	Poultry Consultants		Vet. Practitioner
	Egg Packer/Processor		Poultry Processor
	Processor/Sales		Hatchery Operator
	Feed Manufacturer		Feed Sales
	Equipment Manufacturer/Supplier		Health Products/Technical Sales
	Gov’t Organization		Research
	Education		Extension
	Marketing Boards
	Other (please describe):

Please note that we currently do not accept online Registrations. Please fill out and print this form and mail it to the address below.

REGISTRATION, INCLUDING PAYMENT, SHOULD BE SUBMITTED BY SEPTEMBER 15, 2001

Please note that we currently do not accept online Registrations.
Please fill out and print this form and mail it to the address below.