Pacific Coast Shellfish Growers Association

64th Annual PCSGA & NSA-PCS Shellfish Conference
Monday, September 20, 2010 to Thursday, September 23, 2010
The Hotel Murano
Tacoma, Washington
www.hotelmuranotacoma.com

(Fields marked * are required. Please fill out one form per applicant.)

None Mr. Mrs. Ms. Dr. Other:

* First Name:

MI:

* Last Name:

* Company or Organization:

Position/Title:

* Street Address:

* City:

* State/Province:

* Zip/Postal Code:

Country:

* Telephone:

Fax

* E-mail:

Web site URL:

Representative(s) Exhibiting at Tradeshow (maximum of 3 people):

*Number attending:

*Indicate PCSGA member level:

I am currently a Friend or Subscriber member

I am currently an Associate member

I am currently a Sustaining member

I am currently a Corporate member

I am currently a Patron member

I am not and do not plan to become a PCSGA member

I'd like to join or renew now as :

Associate Member ($275 annually)

Sustaining Member ($600 annually)

Corporate Member ($1200 annually)

Patron Member ($5000 annaully)

(See Allied Member dues schedule and benefits)

*Annual Dues Included: $

*Tradeshow booth costs:

	Before 8/31/2010 Early Bird Rate	After 8/31/2010 Standard Rate
Sustaining, Corporate & Patron Members	Complementary	$175
Associate Members	$325	$475
Non-Members (Includes upgrade to Associate member for current Friend and Subscriber members.)	$600	$750
*Booth Cost $

(Optional) Please sign up as a Conference Sponsor and receive additional advertising in the Program Guide,
and signage at the Conference:

None
Coffee Break Host	$200
Opening Night Reception Host	$350
Grand Awards Banquet Host	$500
Conference Sponsor Cost $


Lake Spanaway Golf Scramble, Monday, September 20, 2010 (Tee times start at 8:30 AM) Lake Spanaway Golf Course. Fee includes golf cart. Prizes to be awarded at Grand Awards Banquet.	Before 8/31/2010 Early Bird Rate	After 8/31/2010 Standard Rate
Golfer Registration	$45	$55	x	=

Before
8/31/2010
Early Bird Rate

After
8/31/2010
Standard Rate

Number

Patron Members
Grand Awards Banquet
(Please indicate number
of attendees for our head count, then mark
number waived for discount.)

=
Patron Members may waive
up to two attendees:
Waive 0
Waive 1
Waive 2

Allied Members
Grand Awards Banquet

$ 45

$55

Patron & Corporate Members
Opening Day Luncheons
(Please indicate number
of attendees for our head count, then mark
number waived for discount.)

=
Waive 0
Waive 1

Allied Members
Opening Day Luncheons

$25

$35

I'll donate the following item(s) to the Student Scholarship Silent Auction:
(Please separate items with commas, and include values.)

Please Create a gift certificate for me based on the information provided above.

I will bring the item(s) with me to the Conference.

I will mail the item(s) to the PCSGA Olympia Office by October 1.

*GRAND TOTAL $

(Dues, Conference Sponsor, Booth and meal costs total)

*Pay by:	Visa/Master Card online. (Button on confirmation page.)
	Visa/Master Card by Phone (Call 360-754-2744 between 8 AM and 5 PM Pacific time.)
	Check by mail

Notes:

Please make checks payable to PCSGA and mail to:
The Pacific Coast Shellfish Growers Association
120 State Ave NE PMB# 142
Olympia, WA 98501

(Submit button must be clicked to submit completed form. Click the button once and wait for the confirmation page. If you have problems with this form, please email pcsga@pcsga.org.)

Conference Cancellation Policy:

By Monday, August 30, 2010 — $50 administration fee
Monday, August 30, 2010 to Sunday, September 12, 2010 — 50% refund
After Sunday, September 12, 2010 — No refund