First Name:

Last Name:

Title:

Company or Organization:

Address:

City:

State/Province:

Zip/PC:

Country:

Phone:

Fax:

E-mail:

Will you need an interpreter?

YES ___  NO ___

Individual Registration (includes admission to conference, opening night reception, trade show and all meal functions). A 5% discounted registration fee is available for firms registering 4 or more people.  Early bird registration is available through August 13, 2004.

Early Bird Registration Rates Through August 13, 2004

Producer Member of MSA

 $94

_______

Agribusiness Member of MSA

 $125

_______

Attendee, Non-Member of MSA

 $175

_______

Spouse

 $75

_______

Registration Rates After August 13, 2004

Producer Member of MSA

$104

_______

Agribusiness Member of MSA

$140

_______

Attendee, Non-Member of MSA

$195

_______

Spouse

$75

_______

Optional Specialty Grains Tour Friday/Saturday, September 10-11, 2004

Tour #1 Registration

$50

_______

Tour #2 Registration (Includes Airfare & Lodging)

$250

_______

Tour #2 Registration (No Airfare or Lodging)

$60

_______

TOTAL

Total Registration Fee:

_______

PLEASE FAX TO 612-339-5673
Cancellation Policy: A complete refund cannot be guaranteed unless received prior to August 27, 2004. If you have questions, please call 612-252-1453 or email bob@mnshippers.org.