Alabama Association of County Agricultural Agents & Specialists REGISTRATION FORM

Alabama Association of County Agricultural Agents & Specialists – REGISTRATION FORM 2017 AACAAS Annual Meeting/Professional Improvement Conference ■ May 30th – June 1st ■ Point Clear, AL

*PLEASE – Use Legible Print to complete this registration form. NAME TELEPHONE (Day) ADDRESS TELEPHONE (Night) CITY, STATE & ZIP Email ADDRESS

*PLEASE – Provide the First & Last Name of all AM/PIC participants for name tags. First Timer? No ( ) Yes ( ) Child (Name for Tag) Guest (Name for Tag) Member (Name for Tag) Child (Name for Tag) Guest (Name for Tag) Spouse (Name for Tag) Child (Name for Tag) Guest (Name for Tag)

*PLEASE – List the number of participants (in each block) for each AM/PIC activity/event.

Date & Time AM/PIC Activity/Event Assembly Spouse Guest(s) Child(ren) May 30th11:00 a.m. – AM/PIC Registration (Rickey Hudson) Azalea Foyer 5:00 p.m. May 30th11:00 a.m. – Scholarship Auction Item Check-In (Tony Glover & Ellen Huckabay) Azalea Salon E 5:00 p.m. May 30th11:00 a.m. – Poster Session Check-In & Set-Up (Tyler Sandlin) Azalea Salon F 2:00 p.m. May 30th 1:00 p.m. – Recreation – Golf Outing (Dennis Peterson - 251-656-5654) Please Call Azalea Foyer 5:00 p.m. May 30th 1:00 p.m. – Professional Development – Session 1 (Committees & Awards) Azalea Salon C 3:00 p.m. May 30th 3:00 p.m. – Professional Development – Session 2 (Teams & Committee Mtg.) Azalea Salon C 5:00 p.m. May 30th 4:30 p.m. – Youth Program Check-In & Reception (Lucy Edwards) Azalea Salon D 5:00 p.m. May 30th 6:00 p.m. – Welcome Dinner – Everyone (Address:14210 S. Greeno Rd., Fairhope) Oak Hollow Farm Barn 8:30 p.m. May 31st 7:00 a.m. – Breakfast Buffet – Everyone Azalea Salon AB 8:00 a.m. May 31st 8:30 a.m. – Youth Program (Departure at 8:45 a.m.) Azalea Foyer 9:00 p.m. May 31st 9:30 a.m. – Professional Improvement Tour (Departure at 9:45 a.m.) Azalea Foyer 3:00 p.m. May 31st 10:30 a.m. – Spouses Program (Departure at 10:45 a.m.) Azalea Foyer 3:00 p.m. May 31st 6:00 p.m. – Banquet & Moody Scholarship Auction (Dress: Coat & Tie) Azalea Salon ABC 9:00 p.m. June 1st 7:00 a.m. – Breakfast Buffet – Everyone Azalea Salon AB 8:00 a.m. June 1st 8:30 a.m. – Youth Program Azalea Foyer 11:00 a.m. June 1st 9:00 a.m. – Spouses Program Azalea Foyer 11:00 a.m. June 1st 12:00 noon – Luncheon sponsored by Life Members – Everyone Gulf Coast Exp. Station 2:00 p.m. Page 1 of 2 (Copy for your Records) Alabama Association of County Agricultural Agents & Specialists – REGISTRATION FORM 2017 AACAAS Annual Meeting/Professional Improvement Conference ■ May 30th – June 1st ■ Point Clear, AL ************************************************************************************************************************ RELEASE FORM – 2017 AACAAS ANNUAL MEETING/PROFESSIONAL IMPROVEMENT CONFERENCE YOUTH PROGRAM I, ______, hereby consent, to allow my child(ren), designated below, participation in the youth activities of the 2017 Alabama Association of County Agricultural Agents & Specialists Annual Meeting/Professional Improvement Conference. Further, I authorize the use of emergency medical care for my child(ren) as shall arise, and deemed necessary by health care professionals. I am providing a copy of my health insurance card (please, attach copy) which covers health care costs for my child(ren).

______Signature Date

Is an Excellent Swimmer Known Medication Child’s Name Date of Birth (Yes/No) Allergic Medical Conditions/Notes s Reactions

************************************************************************************************************************ Registration Fees & County Agents’ Kitchen Donations

N u m Registration Fees (post mark – after May Participants Registration Fees (post mark – by May 10th) Sub-total b 10th) e r Active Member @ $ 90.00 (First Timer – $0.00) @ $ 100.00 (First Timer - $ $45.00) Associate Member @ $ 90.00 @ $ 100.00 $ Life Member @ $ 75.00 @ $ 85.00 $ Spouse @ $ 60.00 @ $ 70.00 $ Child(ren) @ $ 35.00 @ $ 45.00 $ Guest(s) @ $ 90.00 @ $ 100.00 $ Individual Daily @ $ 45.00 (per person, per day) @ $ 55.00 (per person, $ per day)

*Add your 2017 County Agents’ $ Kitchen donation to your registration fees and write one check. List amount of CAK donation here → TOTAL AMOUNT DUE $ Please, make your payment, payable to: AACAAS Please, remit registration form & payment to: Rickey G. Hudson – AACAAS P.O. Box 217 Headland, Alabama 36345-0217 Page 2 of 2 (Copy for your Records)