ACUBE 2004 Annual Meeting Registration Form
Wabash College, Crawfordsville, IN
October 14-16, 2004
NAME: ___________________________________________________ DATE: ____________________
TITLE: ______________________________________________________________________________
DEPARTMENT: _______________________________________________________________________
INSTITUTION: ________________________________________________________________________
STREET ADDRESS: ____________________________________________________________________
CITY: __________________________________ STATE: ______________ ZIP CODE: _______________
ADDRESS PREFERRED FOR MAILING: _____________________________________________________
____________________________________________________________________________________
CITY: _______________________________ STATE: _____________ ZIP CODE: ________________
WORK PHONE: ___________________ FAX NUMBER: ____________________________________
HOME PHONE: ___________________ EMAIL ADDRESS: __________________________________
Registration Fee: Includes meals Friday-Sat noon, refreshments at breaks, and field trips.
Membership status by 08/01/2004 after 10/01/04
Regular Member $ 85 $100
Regular member + 2005 dues $115 $130
New Member (includes 2005 dues) $115 $130
Non-Member $115 $130
Non-Participating guest/spouse $ 55 $ 55
Student (Grad or Undergrad) $ 55 $ 55
K-12 teacher $ 55 $ 55
Friday evening dinner only $ 15 $ 15
TOTAL ENCLOSED (Please make checks payable to ACUBE) ___________
· ________ Pre-meeting field trip to Pine Hills (relic hemlock trees) (Thursday afternoon, October 14)
· ________Birding trip (Friday morning October 15)
· _____Crinoid fossil collecting trip (Friday afternoon October 15)
Special needs (food, facilities, etc.):
Please send registration form and payment to: Dr. Austin Brooks
ACUBE Local Arrangements Chair
brooksa@wabash.edu Department of Biology, Wabash College
765-361-6350, FAX 765-361-6149 Crawfordsville, IN 47933
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