FAS 2017 CONFERENCE REGISTRATION FORM
One form MUST BE COMPLETED for EACH person registering.
Be sure to print a copy of each form for your records.
This form is to be used when sending registration
by mail. A separate form is available for electronic registration.
If you would like to pay using a credit card please click here
(Please check appropriate category.)
(submitted or postmarked after 31 Jan 2017)
|FAS Student Member $20.00
Student Non-Member $30.00
(If you are joining or have not yet paid 2017 dues, please check membership
The annual banquet will be held on Friday, 10 March 2017. IST Commons, Florida Polytechnic University
Time: 7:30 PM
The banquet will be buffet-style.
The banquet speaker will be Dr. George Maul (the 2016 FAS Medalist) from
the Florida Institute of Technology
Pre-registration for the banquet is required.
The cost of the banquet is $35.00
|Card Number:||Exp. Date:||/|
|Your Zip Code:|
|Membership Dues (if applicable)|
|Banquet Tickets ($35.00 each)|
|Payment Total Amount|
Print and Mail completed form to:
Florida Academy of Sciences
P.O. Box 149766
Orlando, FL 32814-9766