12th Plum/Prune Conference

May 20-23, 2012

REGISTRATION FORM

Two Ways to Register
Register On-Line
http://conferences.ucdavis.edu/plum
Online Credit Card or UC Recharge Only
Register by Mail
Credit Card, UC Recharge, or Check
Mail completed form & payment to:
Conference & Event Services
Attn: Plum/Prune Conference
University of California, Davis
One Shields Avenue
442 Memorial Union
Davis, CA 95616
Cancellation Policy
Registration cancellations must be received in writing no later than Tuesday, May 1, 2012. Cancellations received prior to this date will be refunded minus a $100 non-refundable administrative processing fee. Cancellations received after May 1 will not be refunded.
Please email cancellations to
Registration Confirmation:
Once your registration form has been processed, you will receive confirmation by email. This confirmation will include an official University receipt (receipts will not be handed out on-site at the conference). If you have not received an email confirmation ten business days after submitting your registration form, please contact Conference & Event Services at 752-5787 or to confirm your registration form was received. / A separate form is required for each registrant.
Name and affiliation will appear on name badge. Please print legibly or type.
Name:
Last / First / MI
Institution/
Affiliation:
Address:
Street Address
City / State / Zip/Postal Code / Country
Phone: / () / Fax: / ()
Please include area/country code / Please include area/country code
Email:
Required for confirmation purposes, participation roster and receipt.
Registration Fees per person / Early
Registration
by March 15 / Regular Registration March 16 –
May 1 /

Totals

ISHS Members (Membership #______) / $425 / $475 / $
Non-ISHS Members / $475 / $525 / $
Tuesday 5/22 Field Trip Guest Fee / $25 / $25 / $
Closing Dinner Guests –per person / $50 / $65 / $
Total: / $
Will you attend the closing dinner on May 23? Yes No
If you are paying for guests for the dinner, please list their name(s):______
1. Will you need vegetarian meals? Yes No
2. Do you have any special needs?
3. Roommate name for field trip double occupancy room ______
PAYMENT INFORMATION

We do not accept Purchase Orders, nor do we issue invoices for conference registrations

Enclosed is my check/money order made payable to "UC Regents"
Any UC Campus Recharge Account (Include full DaFIS Acct, Sub Acct, Dept, Acct Manager and phone number)
______
Please charge my: / VISA / MasterCard / American Express / Discover
Credit Card Number / Expiration Date and 3 digit code on
back/ AMEX - 4 digit code on the front
Name of Card Holder
(as it appears on card) / *Signature of Card Holder
*Registration Form will not be processed without the signature of the cardholder

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