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June 8th, 2016 University of Florida Gulf Coast Research & Education Center 14625 CR 672, Wimauma, Florida 33598 Advance Registration Form Seed Seminar Name: [Advanced Registration $75 Company: University Faculty & Staff $35 Address: Students N/C (ID Required) city: St Zip. Includes Lunch Payment Method: Phone: Email Check Credit Card — ES Credit Cara No Exp Date — Secunty Cove’ loscover Signature oo a Cru Card nfo Dierent Than Above Gladly accepted i. for your purchases ‘ome: ee = Company area ie <= Aaess: a cay __st Zio. Prone: (Ghone number associated wth credit card biting) Please Return Form To: Florida Seed Association, Inc. 2161 East CR 540A, PMB 236 Lakeland, Florida 33813 Fax: 863-582-9363 Email: awood92014@aol.com Ifyou have any questions please call us at 863-660-6540 or awood92014@aol.com

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