ACUBE 2005 Annual Meeting Registration Form

Southeast Missouri State University, Cape Girardeau, MO

October 13-15, 2005

NAME: _________________________________________________ DATE: ____________________

TITLE: _____________________________________________________________________________

DEPARTMENT:______________________________________________________________________

INSTITUTION: _______________________________________________________________________

STREET ADDRESS: _________________________________________________________________

CITY: __________________________________ STATE: ______________ ZIP CODE: ____________

ADDRESS PREFERRED FOR MAILINGS: _______________________________________________

___________________________________________________________________________________

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
Regular Member
Regular member + 2006 dues
New Member (includes 2006 dues)
Non-Member
Non-Participating guest/spouse
Student (Grad or Undergrad)
K-12 teacher
Friday evening dinner only

by 9/20/05
$ 85
$115
$115
$115
$ 55
$ 55
$ 55
$ 15

after 9/20/05
$100
$130
$130
$130
$ 55
$ 55
$ 55
$ 15

TOTAL ENCLOSED (Please make checks payable to ACUBE) ___________
Sorry, checks or money orders only.

Field Trips: Indicate the trip(s) you plan to attend. Space is limited, register early!

_______ Thursday afternoon: 12 pm- 5 pm: Little Grand Canyon geology and biology trip

_______ Friday morning: 7:00 - 10:00: Birding at Horseshoe Lake, IL

_______ Friday afternoon: 3:00 - 5:30: The Red House (Lewis and Clark interpretive center) &
searching for references to biology in material goods (antiquing)

Special needs (food, facilities, etc.):

Please send registration form and payment to: Dr. Margaret Waterman

ACUBE Local Arrangements Chair

mwaterman@semo.edu Department of Biology, MS 6200

Southeast Missouri State University

(573) 651-2381 Cape Girardeau, MO 63701