Feed International - April/May 2015 - 20
ATTENDEE REGISTRATION FORM To Register online, visit: FIAAP-Conferences.com FIAAP International 2015 Conference Pass $330 USD JUNE 9, 2015 Koelnmesse * Cologne, Germany INCLUDES: * All educational sessions and session materials * A light breakfast, networking lunch and refreshment breaks Your name badge and final program will be available on Tuesday, June 9, 2015, beginning 9:00 a.m. at the Koelnmesse Centre, Room 4. BADGE INFORMATION Formal First Name _____________________________________________ Preferred Nickname _________________________________________ Last Name ____________________________________________________ Professional Suffix _________________________________________ Position ________________________________Title _________________________ Place of Employment _________________________________ Address _______________________________________________________________________________________________________________ City _________________________________________________________ State___________________Postal Code ________________________ Province ____________________________________________________Country_____________________________________________________ Daytime Telephone ________________________________________ Fax Number_____________________________________________________ E-mail Address __________________________________________________________________________________________________________ In case of emergency during FIAAP, contact: First Name __________________________________________________ Last Name ___________________________________________________ Telephone _______________________________________________________ Email ___________________________________________________ SPECIAL NEEDS - If you have a disability and require special assistance, please check the appropriate box: ❑ Hearing ❑ Mobile ❑ Visual ❑ Dietary Restriction _________________________________________________________ JOB FUNCTION: (Select only one) ❑ Corporate/General Management ❑ Mill/Plant Operations ❑ Nutrition ❑ Marketing & Sales ❑ Purchasing ❑ Maintenance, Plant Safety, Engineering ❑ Consulting ❑ R&D ❑ QC/QA/Food Safety ❑ Veterinary ❑ Academic/Government/Association ❑ Logistics/Transportation ❑ Other (please specify) PRIMARY BUSINESS: (Select only one) Is this your first FIAAP? ❑ Yes ❑ No ❑ Manufacture Complete Feeds ❑ Manufacture Premixes/Base Mixes/ Supplements/Concentrates ❑ Grain Elevator ❑ Feed Dealer ❑ Feed Mixer ❑ Farm Mixing ❑ Cooperative ❑ Consulting - Veterinary, Nutrition, or Other ❑ Importer/Exporter ❑ University/Government ❑ Manufacture/Distribute Feed Additives ❑ Manufacture/Distribute Feed Ingredients ❑ Manufacture/Distribute Animal Health Products ❑ Manufacture/Distribute Equipment, Machinery ❑ Supplier ❑ Other (please specify) How did you hear of FIAAP? ___________________________ ❑ E-mail Notification ❑ Mailing ❑ Internet ❑ Other _________________ FEED MANUFACTURED OR SOLD? ___________________________ REFUNDS Written requests for refunds must be postmarked on or before April 1, 2015. FIAAP registrations will be refunded less a $75 USD processing fee. No refunds will be granted if postmarked after April 1, 2015. ❑ Beef ❑ Dairy ❑ Poultry ❑ Pig ❑ Pet Food ❑ Aquaculture ❑ Other Please send your written request to: Via facsimile: 815-966-6416 Via e-mail: EventInfo@WATTnet.net Via mail: FIAAP Accounting 303 N. Main Street, Suite 500, Rockford, IL 61101 ONLINE REGISTRATION IS EASY, FAST AND AVAILABLE 24/7 Go to: FIAAP-Conferences.com and click on ATTEND. FIAAP REGISTRATION FEES - Fees are per person. $330 USD TOTAL $ If mailing-in registration, only Check payments in U.S. funds will be accepted. All credit card payments must be made via online registration. Via Mail: Send to: FIAAP Conferences Accounting, 303 North Main Street, Suite 500, Rockford, IL 61101 In Person/On-site: Registration hours in Koelnmesse Centre are as follows: Tuesday, June 9, 2015 9:00 a.m. - 4:30 p.m. Registration fees are nonrefundable unless written request to FIAAP 2015 is postmarked by April 1, 2015. REGISTER ONLINE, ANYTIME AT: FIAAP-Conferences.com
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