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Trellis Alliance

Trellis Alliance Membership Form

NAME: __________________________________________________________________________________

COMPANY: ______________________________________________________________________________

POSITION: _______________________________________________________________________________

ADDRESS: _______________________________________________________________________________

CITY, STATE, ZIP: ________________________________________________________________________

PHONE: _________________________________________________________________________________

EMAIL**:_________________________________________________________________________________

**It is very important that we have an email address for you, since all Trellis Alliance correspondence with our membership is electronic.

_______Enclosed is a check for my Trellis Alliance membership in the amount of $120, made payable to: UC Regents.

OR

_______Please charge my Trellis Alliance membership in the amount of $120 to my credit card:

VISA OR MASTER CARD #:_________________________________________________________________

(Circle one)

Cardholder’s Name: ____________________________________________________________________

Card Mailing Address: _______________________________________________________________________________

Three Digit Card Code: ______________________Expiration Date: __________________________________

If using a Corporate Card, enter the 12-16 Digit Security Code:____________________________________________

Cardholder’s Signature;__________________________________________________________________________

This signature authorizes the Department of Viticulture & Enology to charge the above to my credit card as indicated in accordance with UC Policy and Procedure.

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REMEMBER: This form is NOT necessary if you are attending Recent Advances in Viticulture and Enology (RAVE), which can be accessed via UC Davis Extension 800-752-0881, or visit their website: http://extension.ucdavis.edu.

Please send this completed form to:

The Trellis Alliance

Department of Viticulture and Enology

One Shields Ave.

Davis, CA 95616

Or fax completed form to: 530-754-9117