Baja California Botanical Symposium
Registration Information

Please print and complete this form, and mail to:
Baja California Botanical Symposium
Department of Botany
San Diego Natural History Museum:
P.O. Box 1390, San Diego, CA 92112 USA
or you may fax the form with your credit card information to (619) 232-5306.

Name: ________________________________________
Position: ________________________________________
Institution: ________________________________________
Mailing Address: ________________________________________
City/State/ZIP or C.P.: ________________________________
Telephone: ________________________________________
Fax: ________________________________________
E-mail Address: ________________________________________

Symposium Registration Fees:

Regular Registration (before 31 July 1997) Late Registration (after 31 July 1997)
Basic ($65)
Student ($45)
Basic ($75)
Student ($55)

Banquet $35 (must be paid by 7 August 1997)

Total $________

I am enclosing a check or money order payable in U. S. dollars to the San Diego Natural History Museum, Baja California Botanical Symposium.

Please charge to my credit card account: [ ] VISA [ ] MasterCard

Your name(s): ________________________________________
Account Number: ________________________________________
Expiration Date: ________________________________________

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