11th IMR Registration Form

11th International Meshing Roundtable
September 15-18, 2002 - Ithaca, New York, USA
Register Early! Deadline: August 16, 2002. Return this form with payment to the address provided.

Name: ___________________________________________ Title: __________________
Company Name: _________________________________________________________
Mailing Address: ___________________________________ Mail Stop: _____________
City: ______________________________ State: ______________ Zip: _____________
Telephone: _________________________ Fax: _________________________________
E-Mail Address: ________________________________________

Security Information
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: _______________________________________________________

Please Indicate Participation (Please circle one answer to the questions below.)

Short Course, Sunday, September 15th @ 100 per person, Statler Hotel
I will attend:							Yes	No
Do you want to receive the proceeding in:				hardcopy	CD	both
Poster Session: Monday, September 16th, Statler Hotel
I will attend:							Yes	No
I will have an entry(s) for the Poster Session:							Yes	No
If yes, how many entries?__________________
Guest(s) will attend: $25 per person. How many? _________
(12 & under 1/2 price, toddlers & infants free)
Banquet and Awards, Tuesday Evening, September 17th
I will attend:							Yes	No
Guest(s) will attend: $50 per person. How many? _________
(12 & under 1/2 price, toddlers & infants free)
Choose Banquet entree for you and for guest(s) that will be attending: Steak______ Chicken______ Fish______ Vegetarian (choose one): Portabella Mushroom________ Pasta_______
T-shirt size:	small	medium	large	x-large	xx-large
Additional T-shirts ($10.00 each): How many? __________ Sizes(s):__________
Will you be attending the CMU Workshop?							Yes	No

Registration Fees Meeting Costs:
$285 BEFORE AUGUST 16, 2002
$325 AFTER AUGUST 16, 2002
$80 Student Registration with Student ID

Registration:

Full Registration @ $285/$325 Per Attendee	______________
Student Registration @ $80 per Attendee	______________
Short Course @ $100 per Attendee	______________
Additional Fees:
Guest(s) attending Poster Session @ $25/person	______________
Guest(s) attending Banquet @ $50/person	______________
Additional T-Shirts	______________
TOTAL AMOUNT ENCLOSED	______________

____VISA _____MasterCard _____AmEx (Check One)

_________________________________	_____________
Card Number	Expires

_________________________________
Signature

Make checks/money orders payable to: Sandia National Laboratories

Mail to:
Sandia National Laboratories
Attn: Lynn Janik Washburn, Financial Coordinator
PO Box 5800, MS-0321
Albuquerque, NM 87185-0321

Registration - Sandia Laboratories Participants Only

_______________________________	____________________________________
Project/Task Number (Active)	Project Manager Approval Signature

Special Needs
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
Lynn Janik Washburn, Financial Coordinator (Mail Stop: 0321)
Office: 505-845-3520 Fax: 505-844-2415 Email: lajanik@sandia.gov