Register Early
DEADLINE: September 7, 2001
Name___________________________________________Title_________________
Company Name_______________________________________________________
Mailing Address___________________________________Mail Stop:____________
City______________________________State______________Zip______________
Telephone_________________________Fax________________________________
E-Mail Address________________________________________
Web Address__________________________________________
US Citizen: Yes____ No____
If No, please fill in the below information. Because this is a Sandia Laboratory sponsored event, DOE requires the below information from non-United States citizens. No other action is required.
Full Name (including middle initial):____________________________
Date of Birth______________________________________________
Place of Birth______________________________________________
Current Citizenship:_________________________________________
| Short Course, Sunday October 7th, Marriott Hotel | ||
| I will attend: | YES | NO |
|
Poster Session: Monday, October 8th, |
||
| I will attend: | YES | NO |
| Guest(s) will attend: $25 per person (12 Under 1/2 price, toddlers/infants free) | YES | NO |
| Name of Guest(s):____________________________ | ||
|
I will have an entry(s) for the Poster Session: |
YES |
NO |
| If yes, how many entries?__________________ | ||
|
I am a Vendor and will have a poster
entry(s) |
YES |
NO |
|
Banquet and Awards - NEWPORT DUNES RESORT |
||
|
Tuesday Evening, October 9th |
||
| I will attend: | YES | NO |
| Guest(s) will attend: $50 per person : (12 under 1/2 price, toddlers/infants free) | YES | NO |
| Name of Guest(s):____________________________ | ||
MEETING COSTS:
$285 BEFORE SEPTEMBER 7, 2001
$325 AFTER SEPTEMBER 7, 2001
$80 Student Registration with Student ID
REGISTRATION:
| Full Registration @ $285/$325 Per Attendee | _________ |
| Student Registration @ $80 per Attendee | _________ |
| Short Course @ $100 per Attendee | _________ |
|
NOT COVERED IN REGISTRATION FEE |
|
| Guest(s) attending Poster Session @ $25/person (12 under $12, infants free) | _________ |
| Guest(s) attending Banquet @ $50/person (12 and under $25, infants free) | _________ |
|
TOTAL AMOUNT ENCLOSED |
_________ |
____VISA _____MasterCard _____AmEx (Check One)
| ___________________________________ | ____________________________________ |
| Card Number | Expires |
_________________________________________________________
Signature
MAKE CHECKS or MONEY ORDERS PAYABLE TO:
SANDIA NATIONAL LABORATORIES
MAIL TO: Tammy Eldred, Conference Coordinator
PO Box 5800, MS0833
Albuquerque, NM 87185-0833
Office: 505-844-0180
Fax: 505-844-8251 or 505-844-8081
Email: tjeldre@sandia.gov
Registration
- Sandia Laboratories Participants Only
| ___________________________________ | ____________________________________ |
| Project/Task Number (Active) | Project Manager Approval Signature |
Please indicate here if you require special accessibility or
accommodations at this meeting. My requirements are: (e.g. vegetarian, disability
accommodations, audio/visual requirements for speakers, etc.)
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
For Registration Information
Tammy Eldred, Conference Coordinator (Mail Stop: 0833)
Office: 505-844-0180 Fax: 505-844-8251 Email: tjeldre@sandia.gov