Official Registration Form
2009 North Atlantic Poultry Bioseurity
and
Pest Management Workshop
Wednesday, June 24, 2009
Room 100, W.B. Young Building
University of Connecticut
Registration Deadline is June 17, 2009
Please fill in ALL blanks
Name(s) (First, Last)
Street Address
City
State
Zip Code
Phone:
Email
Organization/Farm
Number Attending
Would you like to display/discuss a product/service?
Yes
Product
Service
Total Due ( x $50 per person)
Cash or Check only.
Make Checks Payable to:
Poultry Pest Workshop
Comments:
If you have questions contact Dr. Mike Darre
michael.darre@uconn.edu or call 860-486-1008