Name: _____________________________________
Badge Name: _______________________________
Address: ________________________________
________________________________
City: _________________ State/Province: ___
Zip/Postal Code: ____________
Country: ____________________
Phone: ______________________ Fax: ____________________
e-mail : __________________________________________
REGISTRATION FEES: There are no one-day
pro-rated registration fees. Participant registration fees cover
admission to all scientific sessions, refreshment breaks,
accommodations, Welcoming Reception, and conference field trip.
Guest
registration is available for those who wish to attend the
reception and field trip only. All participants must
register
in advance by October 4, 1996. There will be no on-site
registration for this conference.
__ PROFESSIONAL REGISTRATION FEE $285.00
__ STUDENT REGISTRATION $175.00
__ GUEST REGISTRATION $50.00
(Guest's Name:___________________________________________)
ACCOMMODATIONS: Accommodations will be at the
Melia Puerto de la Cruz Hotel. Room rates are $90
single and $130 double per night and include breakfast. Please
indicate your arrival and departure dates and room type
preference:
__ Single Room $ 90/night x ____nights = $_______ __ Double Room (2 twin beds) $130/night x ____nights = $_______ __ Please indicate any special requests, needs or restrictions, such as disabilities, dietary restrictions: _______________________________________________________________ _______________________________________________________________ Arrival Date: _____________________ Time:___________ Airline/Flight No.*: _____________________ Departure Date: _________________________ Time: _______________ Do you need information about transfers to/from the Tenerife Airport to the hotel? __YES __NO*NOTE: U.S. Participants, leaving from JFK Airport, must depart on November 9th in order to arrive in Tenerife by November 10th. PRE-CONFERENCE FIELD TRIP (OPTIONAL): This trip will leave each morning from the hotel at 9:00 A.M. and return to the hotel around 6:00 P.M.
__2-Day Trip Sat & Sun, November 9-10, 1996 $90 __1-Day Trip Sun, November 10 $60 Would you be willing to help with the driving? __YES (Remember to bring your driver's license) TOTAL REGISTRATION & HOUSING RESERVATION FEES PLUS OPTIONAL FIELD TRIP: $_________ PAYMENT: Payment in U.S. dollars must accompany this form. __Check (payable to AGU) __AMEX __VISA __MasterCard Cardholder's Name: ________________________________________________________________________________ Card No.: _______________________________________________________ Exp. Date:________________________ Signature: ________________________________________________________________________________________ COMPLETE THIS FORM AND RETURN BY October 4 TO: AGU-Canary Islands, 2000 Florida Ave., NW, Washington, DC 20009; Fax: 202-328-0566; or E-mail complete registration information to awhite@agu.org . NOTE: Fax or e-mail registrations must include credit card payment.
November 10-16, 1996
Tenerife, Canary Islands
The undersigned does hereby assume any and all risks
involved in my participation in the offered FIELD TRIP
TO VOLCANIC FEATURES OF TENERIFE through the
American Geophysical Union (AGU) for the Chapman
Conference on Shallow Level Processes in Ocean Island
Magmatism: Distinguishing Mantle and Crustal
Signatures, and does hereby save and hold harmless the
AGU from any and all claims, losses and damages
(including attorney's fees and any costs involved because
of said claims), on account of: lost or damaged articles;
accident; any mishap due to alcohol or drug abuse; death;
injury; illness; disruption; delays or cancellations caused
by weather conditions; any mechanical or electrical
difficulties; strikes; lockouts; act of God; or other events
beyond their control.
I understand that I am responsible for my own medical
and liability insurance.
______________________________________
Participant's Name (please print)
______________________________________
Signature of Participant
______________________________________
Date
(Please sign and fax form back to Almeta White, 202-328-0566)
November 10-16, 1996
Tenerife, Canary Islands
The undersigned does hereby assume any and all risks
involved in my participation in the offered PRE-CONFERENCE FIELD
TRIP TO VOLCANIC
FEATURES OF TENERIFE through the American
Geophysical Union (AGU) for the Chapman Conference
ON Shallow Level Processes in Ocean Island
Magmatism: Distinguishing Mantle and Crustal
Signatures, and does hereby save and hold harmless the
AGU from any and all claims, losses and damages
(including attorney's fees and any costs involved because
of said claims), on account of: lost or damaged articles;
accident; any mishap due to alcohol or drug abuse; death;
injury; illness; disruption; delays or cancellations caused
by weather conditions; any mechanical or electrical
difficulties; strikes; lockouts; act of God; or other events
beyond their control.
I understand that I am responsible for my own medical
and liability insurance.
______________________________________
Participant's Name (please print)
______________________________________
Signature of Participant
______________________________________
Date
(Please sign and fax form back to Almeta White, 202-328-0566)
