FLORIDA NATIVE BROMELIAD SEED COLLECTION FORM
SAVE FLORIDA'S NATIVE BROMELIADS
Return original form to:  	Seed Collection Project

				C/O Carolyn Schoenau, Database Coordinator

		  		PO Box 12981

				Gainesville FL 32604-0981



Keep a copy for yourself if you wish.  DO NOT SEND SEED TO THIS ADDRESS.

Form must include email address, telephone number or fax number of seed collector.

A separate form must be completed for each Species and for each different location.

An online version of this form is available at http://fcbs.org/

Photos can be sent with the form or if available in digital form can be emailed to

webmaster@fcbs.org for inclusion in the Database.
1)* Collector Name:___________________________________________________________________

2) Collector Email Address:_____________________________________________

3)* Collector Telephone:___________________________________

4) Collector Fax number:___________________________________

5)* Permit number or relationship to landowner:___________________________________________
DOACS Regulated Plant Index Harvesting Permit (DACS-08135)
Permit # is typed in upper right hand corner of permit.
If you are not required to have a permit, give your position (e.g., park biologist).

6)* Species Collected:______________________________________________________________
collected species must be one of the following Catopsis berteroniana, Catopsis floribunda, Catopsis nutans, Guzmania monostachia, Tillandsia balbisiana, T. fasciculata, T. flexuosa, T. paucifolia, T. pruinosa, T. simulata, T. utriculata, T. variabilis

7) Variety (if appropriate):____________________________________________

8) Local Bromeliad Society:________________________________________________________________
e.g. Bromeliad Society of Central Florida

9)* Date of Collection:_________________________________________________________
(give it in military style: day - first 3 letters of month - year in full)
- e.g., 4-JUL-2001

10)* County of Collection:_______________________________________________________

11)* Locality:________________________________________________________________
e.g. 2.4 mi S of Palmdale on Hwy 29

12)* Habitat:_________________________________________________________________
e.g. from one of a group of cypress trees

13/14)* Coordinates:


           Latitude:___________________________________

           e.g. 2653.59'N

           Longitude:_________________________________

           e.g. 8123.49'W

  

15)* Name of person in charge of germination/growth:
____________________________________________________________________________

16)* Address of place where seed is being germinated/grown:
_____________________________________________
_____________________________________________
_____________________________________________

17)* Photos: (Please check one)
____I will email my photos to webmaster@fcbs.org
____I will mail my photos or slides for scanning
____Sorry, I have no photo(s)

18) Comments:_____________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

*Required fields