AKA '99 FISH SHOW ENTRY REGISTRATION

(PLEASE PRINT)  

CONVENTION REGISTRATION  NUMBER ______________________         PAGE   _______  OF  _______

NAME:______________________________________________________PHONE__________________

ADDRESS:___________________________________________________________________________

CITY__________________________________STATE (COUNTRY)____________ ZIP_______________

E-MAIL ADDRESS_____________________________________________________________________

Bag # Genus/Species Population/Location Class
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PLEASE DO NOT FILL IN THE BAG NUMBER OR CLASS.  BOTH ARE ASSIGNED AT THE CONVENTION.

MAIL TO:   Phil Schneidewind, 1521 Schaumberg Road, Streamwood, IL 60107.