1999 Annual Western Division AFS Meeting
University of Idaho
Moscow, Idaho
July 12-14, 1999

Registration Form

Name:__________________________________________

Title: ___________________________________________

Affiliation: _______________________________________

City, State  Zip: ___________________________________

Phone Number: ___________________________________

Fax number: _____________________________________

Email Address: ___________________________________

If you intend to pay by credit card, please provide the following information:

Type of card: ________________________________________

Cardholder’s name: ___________________________________

Card number: ________________________________________

Expiration date: _______________________________________

Cardholder’s signature: _________________________________

Cardholder’s address (if different than registration address): ______________________________________________________________________________

There is a $15.00 pre-registration financial break. Checks should be made payable to: Western Divsion AFS.  To benefit, your pre-registration form must be received no later than 5:00 PM July 9, 1999 and sent to:

Western Division AFS Registration
c/o Environmental Consultants
P.O. Box 925
Eagle, Idaho 83616

FAX 208-939-4086