Conference Registration Form

Please return completed form by mail or fax to the address provided. 
Seating capacity is limited so please register as soon as possible.

The conference fee is $150.00 for bankers and $75.00 for their customers. Spouses and students $25.00. 
Registration fees include all sessions, refreshments throughout the day, and lunch.

 	Name		___________________________________________________

 	Name		___________________________________________________

	Name		___________________________________________________

	Name		___________________________________________________

	Company	___________________________________________________

	Address          ___________________________________________________

			___________________________________________________

	Phone		____________________________________________________

	
    Registration Cost
     ___ # Lenders and Ag Service Providers @ $150 =  _______

     ___ # Farmers and Producers @ $75 =                      _______

     ___ # Spouses and Students @ $25 =                         _______

            Total Registration Amount:                        _______
 

	Method of Payment (Check one)
	____ Check (Payable to UT Martin)
	___ Discover
	___ Visa
	___ Master Card

 	Credit Card No. ______________________________ Exp. Date ____________

	Signature ________________________________________________________

Mail or Fax Payment To:
Dr. Tom H. Payne
Dunagan Chair of Excellence in Banking
College of Business and Public Affairs
The University of Tennessee at Martin
109 Business Administration Bldg.
Martin, TN  38238

Phone: 731-881-7324
Fax:     731-881-7323
Email: tpayne@utm.edu