May 30th, 2018

Florida Farm Bureau Building

5700 SW 34th ST, Gainesville, Florida

Advance Registration Form

Seed Seminar
Name: ____________________________________________________
Advanced Registration $75
Company: ____________________________________________________ University Faculty & Staff $35

Address: ____________________________________________________ Students N/C (ID Required)

City: _____________________________ St: ______ Zip: _________ Includes Lunch

Phone: _______________________ Email: ______________________ Payment Method:

Check

Credit Card

Credit Card No. ___________________________________________ Exp Date: _______________

Security Code: _____________

Signature: _________________________________________

Credit Card Info if Different Than Above:

Name: ________________________________________________________

Company: ________________________________________________________

Address: ________________________________________________________

City: ________________________ ST: ________ Zip: ____________

Phone: ____________________________ (phone number associated with credit card billing)

Please Return Form To:

Florida Seed Association, Inc.
2161 East CR 540A, PMB 236
Lakeland, Florida 33813
Fax: 863-582-9363
Email: awood92014@aol.com

If you have any questions please call us at 863-660-6540 or awood92014@aol.com