Registration Form

Register Early
DEADLINE: September 10, 1999


Name___________________________________________Title_________________
Company Name_______________________________________________________
Mailing Address___________________________________Mail Stop:____________
City______________________________State______________Zip______________

Telephone_________________________Fax________________________________
E-Mail Address________________________________________
Web 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

Short Course, Sunday October 10th, Embassy Suites Resort
 I will attend:   o YES   o NO

 

Poster Session: Monday Evening, October 11th, Heavenly Mountain Tram

I will attend:   o YES   o NO
Guest(s) will attend: $25 per person (12 Under 1/2 price, toddlers/infants free)   o YES   o NO
 Name of Guest(s):____________________________    

 

I will have an entry(s) for the Poster Session:

 

o YES

 

o NO

If yes, how many entries?__________________    

 

I will have an entry(s) for the Vendor Exhibit:

 

o YES

 

o NO

 

Banquet and Dinner Cruise on Paddle Wheel Boat Cruising Lake Tahoe

 Tuesday Evening, October 12, 1999

   
 I will attend:   o YES   o NO
Guest(s) will attend: $50 per person : (12 under 1/2 price, toddlers/infants free)   o YES   o NO
 Name of Guest(s):____________________________    


Registration Fees

MEETING COSTS:

$285 BEFORE SEPTEMBER 10, 1999
$325 AFTER SEPTEMBER 10, 1999
$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 $12.50, 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, MS0841
Albuquerque, NM 87185-0841

Office: 505-844-0180
Fax: 505-844-8251
Email: tjeldre@sandia.gov


Registration - Sandia Laboratories Participants Only
___________________________________ ____________________________________
  Case Number (Active)   Case 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
Tammy Eldred, Conference Coordinator (Mail Stop: 0841)
Office: 505-844-0180 Fax: 505-844-8251 Email: tjeldre@sandia.gov