WWW Meeting Registration Form - 11th International Conference on Secondary Ion Mass Spectrometry (SIMSXI)- Hilton at Walt Disney World Village- September 7-12, 1997
Name:___________________________________________________________________________
Company/Institution:_______________________________________________________________
Mailing Address:___________________________________________________________________
Mailing Address:___________________________________________________________________
City: _________________ State/Province:___________ Postal Code (Zip):______________
Country: __________________
Telephone: _____________________ Fax: _____________________ Email:_________________
Name and Affiliation as it should appear on your name badge:_______________________
___________________________________________________________________________________
___ Regular Registration $395.00
___ Student Registration $195.00
___ Biological SIMS Workshop $50.00
___ Companion Registration $150.00
Enter Total Registration Amount $____________
Check Meal Choice for Tuesday Conference Dinner: Chicken ___ Gulf Fish
___
Check Meal Choice for Companion Conference Dinner: Chicken ___ Gulf Fish
___
Check or Money Order is Enclosed. Make Check Payable to SIMS XI___
Charge Total Amount to VISA or MasterCard (no other cards accepted)___
VISA or MasterCard #: _______________________________ Expiration Date
(mm/yr): ____________
Cardholders Signature (required): ___________________________________
This form must by accompanied by full payment for the total amount.
Checks must be in U.S. Dollars and payable through a U.S. bank. We regret that we do not accept purchase orders.
SEND TO: SIMS XI Registration, 1201 Don Diego Avenue, Santa Fe, NM 87505 (USA)
FAX: (505) 989-1073 -- Faxed registrations must be charged to VISA or MasterCard