National Gap Analysis Program Meeting

Return this form along with your check (make checks payable to:  BAMI) or purchase order to:

Brookings Area MultiPlex, 824 32nd Ave, Brookings SD  57006

Name

Employer/Organization

Complete Address (Employer  /  Home   Circle One)

City                        State                        Zip

Daytime Phone                        Home Phone

Fax                        Email

Request for special needs:

Registration Fees                        On or Before 5/29                        After 5/29

Full Registration                                                 $150.00                                    $165.00

Day Registration (6/18)                                       $  60.00                                    $  70.00

Day Registration (6/19)                                       $  55.00                                    $  65.00

Day Registration (6/20)                                       $  50.00                                    $  60.00

Additional Tickets for Monday Banquet:  #         at $25.00

Please choose your main dish:

               #                         Grilled Steak        #                         Grilled Walleye

Field Trips:       

Crystal Springs Memorial Preserve  #       at $5.00 each

EROS Data Center #            attending (no charge)

Total Amount Due:  $            

Your name and address information will be included on a participant list in the meeting packet.  If you do not want your information on this list, please sign here