Registration Form
The 2013 Mid-Atlantic Horticulture Short Course February 4-7, 2013 BIG SAVINGS
Early Bird Rates + Group Discount (10 or more) Available until January 13
Register TODAY ONLINE: www.mahsc.org ... PEN & PAPER 1. Select classes & fee added events on back of form 2. Complete costs & contact info here ... FAX: (757) 366-9604 (credit card/PO only) ... MAIL: The VA Horticultural Foundation PO Box 64446 Virginia Beach, VA 23467 ..........................................
QUESTIONS?
EARLY BIRD Received by Jan 13
REGULAR Received Jan 14 - 20
LATE Received after Jan 20
$95
$130
$170
2 days
$190
$225
$265
3 days
$285
$320
$360
4 days
$380
$415
$455
Days Attending (Mon, Tues, Wed, Thu)
Number of Attendees
1 day
* Less 10% group discount if applicable * Irrigation Workshop: Landscape Drainage Design: Monday (IRR) – $110/person Grafting Workshop: Monday Evening (GT1) – $50/person Tree Nursery Forest Tour: Tuesday (NFT) – $50/person Bonsai Workshop: Tuesday Evening (BZ) – $50/person Lunch & Learn: Mon Tue Wed – $25/person/day Enter the number of shirts by size and color MOCHA Reg. Short Sleeve ($13) 0 S
0M 0M MOCHA Fitted S-Sleeve ($13) 0 S 0 M YELLOW Fitted S-Sleeve ($13) 0 S 0 M NATURAL Long-Sleeve ($17) 0 S 0 M
YELLOW Reg. Short Sleeve ($13) 0 S
0L 0L 0L 0L 0L
0 XL ∧ ($14) 0 2XL ∧ ($14) 0 3XL 0 XL ∧ ($14) 0 2XL ∧ ($14) 0 3XL 0 XL ∧ ($14) 0 2XL ∧ ($14) 0 3XL 0 XL ∧ ($14) 0 2XL ∧ ($14) 0 3XL 0 XL ∧ ($18) 0 2XL ∧ ($18) 0 3XL
** Become a Friend of the Foundation with your donation ** TOTAL AMOUNT DUE CONTACT INFORMATION
Call (757) 523-4734 or send an email to info@vahort.org. ..........................................
Name: City:
State:
CANCELLATIONS
Phone:
Email:
Subject to a $25 cancellation fee per registrant. If registrant cannot attend, substitutions can be made with identical schedule by contacting MAHSC as soon as possible. NO refunds after Jan. 20, 2013. ..........................................
TOTAL
Address:
Company: Work Home
Zip:
PAYMENT INFORMATION Payment Type
Check (to TVHF) PO Visa MasterCard AMEX
Credit Card #
Exp Date:
Name on Card
Card Verif #:
Signature
PHOTO RELEASE CLAIM
MAHSC reserves the right to use the photos taken at the 2013 MAHSC by event photographers for future promotional purposes. By submitting this conference registration form, registrants are acknowledging that they have read and understood this Photo Release Claim.
OCCUPATION / INTERESTS (if registering more than 1 person, indicate the number in each category) Please check the BEST category that describes your occupation/interest:
0 Landscape Management 0 Tree Care/Forestry 0 Nursery/Greenhouse 0 Sports Turf/Golf 0 Landscape Architecture 0 Garden Center/Retail 0 Research/Educator 0 Landscape Design 0 Pond Maint/Aquatics 0 Student/Volunteer Please select one: 0 Management 0 Staff Please select one: 0 Government 0 Private Business 0 Other
* 10% discount for groups of 10 or more; registrations must be submitted together. For groups, submit this form with payment. Include one copy of the back of this form for each attendee. ** The Virginia Horticultural Foundation is a 501(c)(3) nonprofit organization. Donations may be tax deductible. www.vahort.org