I Am a Member Of: AAFC ASFFA Ladies Auxiliary

Participant Information

June 14 through 17, 2007

Name______

Department______

Name of Guest______

Address______

City______State______Zip______

Phone Number______e-mail______

I am a member of: □AAFC □ASFFA □Ladies Auxiliary

Conference Registration Fees

Before June 1 After June 1

Entire Conference...... …………………………….…□$75 (single) □$100 (single)

□$125 (couple) □$175 (couple)

Banquet Only……………………………………… ..□$35 (each) □$35 (each)

□Golf Tournament $ 75 (fee includes golf expenses and lunch)

□Please check here if a cart is needed

Shirts

Each individual registered will receive a shirt. Please indicate the size you will need. Additional shirts may be pre-purchased now or purchased at Convention. Sizes and prices offered include: YL, S, M, L, and XL $10. XXL and XXXL $15.

____ Youth Large ____ Adult Medium ____ Adult X Large ____ Adult XXX L

____ Adult Small ____ Adult Large ____ Adult XX Large

Total Registration fee$______

Hotel Information (Please mention you are with Delta Heat ’07 Convention)

Best Western ▪ Interstate 40 & Hwy 1B▪Forrest City, AR 72335 ▪ (870)633.0870

This will be the conference hotel. The hospitality room will be located here.

Room Rate $75/night

Holiday Inn▪200 Holiday Drive▪Forrest City, AR 72335▪(870)261.7575

Room Rate $75/night

Fax, Mail, or phone in your registration and payment to:

(Please make checks payable to Delta Heat ’07)

Delta Heat ’07

Attn: Convention Coordinator

300 Garland Avenue

Forrest City, AR 72335

Ph (870)633-2414 fax (870)261-1428