West Central Mosquito and Vector Control Association

West Central Mosquito and Vector Control Association 2015 Regular Membership Dues & Annual Meeting Registration Form Name Agency Address City State Zip Phone number Email ______

West Central Mosquito and Vector Control Association 2015 Dues: $25 yearly membership only and will not be attending Annual Meeting.

2015 Annual Meeting: $105 per person (includes WCMVCA 2015 membership; breakfast, lunch and breaks on Wednesday March 11; breakfast and breaks on Thursday, March 12)

$125 per person after February 23, 2015 or on site

Donation to Hollandsworth Scholarship Fund

Total due Check Enclosed. Make check payable to WCMVCA

Registration includes pre-Meeting Mosquito ID & Biology on Tuesday, March 10, 2015 from 1:30 to 4pm at Red Cliffs Lodge. Seating is limited so RSVP is needed.

Return this registration form by Feb 23, 2015 to: For meeting information, contact: Steven DeFeyter, Treasurer Tom Janousek WCMVCA (402) 672-0930 PO Box 4031 [email protected] Grand Junction, CO 81502 – 4031 Phone: (970) 260-2187 [email protected]

Hotel info: March 10-12, 2015 at Red Cliffs Lodge, Mile 14, Hwy 128, Moab, UT 84532 Tel: 435-259-2002. Meeting: Wednesday March 11: 8:00am to 4:30pm; Thursday March 12: 8:30am to noon.