PACIFIC NORTHWEST AERIAL APPLICATORS ALLIANCE

891 Prater Rd Ellensburg, WA 98926

509-968-3386 FAX 509-968-9330

pnwaaa@elltel.net pnw3a.com

REGISTRATION FOR 2007 RECERTIFICATION CONFERENCE

Pasco, Washington –Red Lion Hotel, November 4^th 5^th and 6^th

and

OPERATOR or PILOT MEMBERSHIP APPLICATION For 2008

We recognize the importance of PNWAAA to the Agricultural Aviation Applicator, the direct and indirect benefits to our business resulting from PNWAAA’s service and wish to add our support. We have enclosed our payment for tax-deductible dues for the 2008 calendar year.

$75.00 FOR PILOT circle one $150.00 FOR OPERATOR

NAME_____________________________________________________________________________

COMPANY NAME___________________________________________________________________

ADDRESS__________________________________________________________________________

CITY, STATE, ZIP___________________________________________________________________

PHONE_______________________________ E-MAIL______________________________________

ADDITIONAL REGISTRANTS_________________________________________________________

REGISTRATION - MEMBER 190.00 LATE 205.00 $_________________

REGISTRATION - NON MEMBER 400.00 LATE 415.00 $_________________

Extra banquet ticket Monday Night EACH 35.00 $_________________

Extra ticket for Luncheon on Tuesday EACH 20.00 $_________________

PNWAAA MEMBERSHIP 75.00 PILOT or 150.00 OPERATOR $_________________

TOTAL ENCLOSED $___________________

PAYMENT METHOD

Check Enclosed # ___________________ or Credit Card (VISA,MC,AMEX) ___________________________

Amount $ _______________ Card Number _________________________________ Exp Date _____________

Name on Card __________________________ Signature ___________________________________________

Billing Address _____________________ City ____________________ State ___________ Zip ___________

PLEASE MAIL REGISTRATION BY 10-22-07 TO AVOID LATE FEES