5th National Black Land Loss Summit
"Controlling Our Destiny from the Land to the Man"
February 7-9, 2003
Greensboro Metropolitan Area, North Carolina
DUDLEY INN & CONFERENCE CENTER
900 E. Mountain Street, Kernersville, NC 27284
Phone (336) 996-2030, Fax (336) 996-4261
NAME
_________________________________________________________________TITLE___________________________________ORGANIZATION________________________________________________________________________________________________
ADDRESS______________________________________________________________________________________________________
CITY/STATE________________________________________________________________ZipCode__________________________
PHONE _______________________________________________________________FAX_____________________________________
E-MAIL________________________________________________________________________________________________________
Registration Fee ____$100.00
Includes reception, noon meal on Saturday, and conference program and materials. Please note that a registration fee is required for each person attending.
Early Registration Fees
Must be postmarked by January 25, 2003
____$75.00 for Black farmers and family ____$50.00 for BFAA members and family
(National office has membership roster.)
____$90.00 for all others
Limited scholarships available for Black farmers (contact Gary R. Grant if you have questions – (252) 826-2800)
Names of any family members attending:
1)_____________________________________________ 3)_____________________________________________
2)_____________________________________________ 4)_____________________________________________
TOTAL NUMBER OF PARTICIPANTS___________ X $___________ REGISTRATION FEE
I will not be able to attend, but wish to make the following contribution to the Land Loss Fund: $__________
TOTAL AMOUNT ENCLOSED $________________
Please make checks/money orders payable to: Land Loss Fund, P.O. Box 61, Tillery, NC 27887, (252) 826-2800