Name 1: _____________________
Name 2: _____________________
Address: _____________________
City/State/Zip: _________________
Phone (Day): __________________
Phone (Evening): _______________
Email: _______________________
| Cost | Quantity | - Total - | |
|
Foray: Thu., Aug. 26, - Sun., Aug. 29, 2004 Foray Fee $130.00 includes: - Foray Activities - Meals (Buffet breakfast, sack lunch & buffet dinner on Friday and Saturday, breakfast on Sunday) Foray registration begins at 4:00 PM on Thursday | 130 | ||
|
Banquet to celebrate the NMMS 20th Anniversary at Carlo Gislimberti’s Villa Fontana in Taos, NM Sunday, August 29, at 2:00 PM. Cost is $50 per person for multi-course dinner including wine. | 50 | ||
|
Special Foray T-shirt: $10 each Qty & Size: ________@M ________@L ________@XL ________@2XL | 10 | ||
| Grand Total |
Make your check payable to: NMMS (New Mexico Mycological Society).
Be sure to sign and date the release at the bottom of the application form.
Return this registration form and your check by August 2, 2004 to:
NMMS Foray
c/o: Ann Floyd
4412 Cliff Base Dr. NW
Albuquerque, NM 87120-1301
Accommodations at Angel Fire Resort are the responsibility of the applicant. A block of rooms is reserved for the NMMS Foray. Call before July 19, 2004 to secure a room and mention you are with the foray. The rooms have 2 queen-size beds and a refrigerator, at the special rate of $65.00 per night.
Angel Fire Resort phone number: 800-633-7463.
For other accommodations, contact the Angel Fire Chamber of Commerce: 800-446-8117.
Late Fee: $30.00 (Reservations received after August 2, 2004.)
Cancellation Fee: $50.00
For maps and additional information refer to: www.mycowest.org
Email contact: ann@mycowest.org
Telephone contact: 505-839-3890
For Name Tags (please print):
|
Name (1) ________________________ Hometown _______________________ Club Affiliation ____________________ |
Name (2) ________________________ Hometown _______________________ Club Affiliation ____________________ |
Use space below for additional names.
LIABILITY WAIVER
Each person signing below hereby releases NMMS, their officers, and members from
any and all liability or loss arising from any accident, injury or illness which may result
from activities of the 2004 NMMS Foray.
Signature: ___________________________________ Date: ____________________
Signature: ___________________________________ Date: ____________________