Sample Registration Form

Potato Association of America

92nd Annual Meeting

August 10 to 14, 2008 – Adam’s Mark Buffalo-Niagara Hotel – Buffalo, NY



Your registration is not valid until payment is received:

Three Ways to Register

1) Register On-Line                                          3) Register by Mail (mail completed form & payment)                        Sue Thompson

15 A Plant Science Building

2) Register by FAX                                                     Department of Horticulture

Complete this form and fax to: 607-255-0599              Cornell University

Ithaca, NY 14853

Delegate Information
Preferred name, full name and affiliation will appear on name badge. Print legibly or type.

¨ Prof.  ¨ Dr.  ¨ Student  ¨ Other _________________ PAA or EAPR Membership # _________________


Name: _______________________________________________________________________

First Name                             MI                                       Last Name (Surname)



Registrant’s preferred first name for badge


Institution/ Affiliation: ___________________________________________________________


Student Verification
I verify that the person whose name appears on this registration form is a student.


____________________________________     ________________________________________

Advisor’s Signature                                                   Print Name Accompanying Persons Information

 Accompanying Persons Information

Name: _______________________________________________________________________

First Name                             MI                                       Last Name (Surname)



Registrant’s preferred first name for badge


Delegate Mailing Address

Address: ___________________________________________________________________

                 Street Address



City                                       State                    Zip Code                   Country


Phone:   __(______)__________________________   Fax:  __(_____)____________________

Please include area, city and country codes        Please include area, city and country codes


E-mail: _______________________________________________________________________

            Required for confirmation purposes, participation roster and receipt.

If an e-mail address is not provided the above information will be sent via regular mail




Registration Fees
  # of


Payment before

 July 15


After July 15


Total $

PAA – EAPR Member Registration   . ¨ $275 ¨ $375


Non-Member Registration

To save non-membership fees, please join the PAA now ($100) by going to PAA website:



¨ $375 ¨ $475


Student Registration Requires advisor signature (see student verification) ¨ $140 ¨ $190


Accompanying Persons Registration Fee includes 4 breakfast buffets, 3 lunches and Welcome Reception .


¨ $75 each ¨ $100 each


Golf Scramble  – Sunday August 10  . ¨ $45 each ¨ $45 each


Henry De Jong Sponsorship Bike Ride (and challenge from Larry Hiller) for the PAA Endowment Fund  (US tax deductible donation)


Industry Program –Tuesday August 12 – Fee includes break and lunch  . ¨ $30 each ¨ $30 each


Wine and Cheese Social (plus Live Auction and Variety Show) – Tuesday August 12 No fee, but please let us know you are coming!  

# of Attending____________

Agriculture Tour – Wednesday August 13   . ¨ $40 each ¨ $55 each


Optional PAA-sponsored (5) tours with Gray Line

Please mail or fax your selections to Gray Line.  Use separate enclosed Gray Line Bus Form.

BBQ – Taste of Buffalo – Wednesday August 13  . ¨ $25 each ¨ $35 each


Awards Banquet – Thursday August 14

Note: free banquet ticket for graduate students in awards competition 

 . ¨ $35 each ¨ $45 each


   . Registration Total $
Conference Questions
1.  Do you have any special dietary needs? [    ] Yes  [    ] No


2.  Do you have any other special needs? [      ]   Yes  [     ] No


Cancellation Policy
All cancellations must be received before Monday, August 4, 2008.  Cancellations are processed as soon as possible less cancellation fees listed below.

Member Registration: $55                   Non-member Registration: $55       Student Registration $45

Accompanying person’s registration: $20   Industry Program  $10              Optional on-site event selections  25%

Registration Submission
Submit your registration form online at or send a copy by fax (attn:  Sue Thompson) at (607)255-0599 or regular mail to:  Sue Thompson, 15A Plant Science Building, Department of Horticulture, Cornell University, Ithaca, NY 14853
Payment Information
Enclosed is my check (must be in U.S. dollars from a U.S. bank) or a money order made payable to Cornell University or charge my credit card account as follows:

[     ] VISA   [    ] MasterCard   [     ] American Express   [    ] Discover 

Credit Card Number: ___________________________Expiration Date_______________

CCV#  ____________


Name of Card Holder: __________________________________________________________________

(as it appears on card)


                                                                                       Total Amount Due: $______________

*Registration Form will not be processed without the signature of the cardholder.

** The CCV (Credit Card Validation) number is a 3 digit code printed on the BACK of your card in the signature panel. For American Express it’s four numbers on the front of the card.

Registration Confirmation
Once your registration form has been processed, you will receive confirmation by e-mail.  If an e-mail address is not provided the confirmation will be sent via regular mail.   This confirmation will include a receipt. If you have not received this correspondence in ten (10) business days after submitting your registration form, please contact Sue Thompson at 607-255-7889 or [email protected] to inquire whether your completed registration form was received.
Please call Don Halseth at 607-255-5460,  [email protected] or Joe Sieczka at 631-298-4423,   [email protected].