Name:_________________________________________________________________
Badge Name: ___________________________________________________________
Address:_______________________________________________________________
_______________________________________________________________________
City: ___________________ State/Province: ________ Zip/Postal Code: ____________
Country: ___________________ E-mail:___________________
Phone: ___________________ Fax: __________________
Guest(s): _______________________________________________________________
REGISTRATION FEES: There are no one-day registration fees. A $25.00 late fee will be charged for any registrations received after the preregistration deadline. Participant registration fees cover admission to all scientific sessions, refreshments, reception, and conference banquet. Please check the appropriate registration box:
| [ ] Regular $265.00 | [ ] Student $120.00 |
GUEST FEES: Tickets must be purchased for guests who wish to attend these events.
| [ ] Reception $15.00 each x ____ tickets=____ | [ ] Banquet $35.00 each x ____ tickets=____ |
TOTAL GUEST FEES $____________
TOTAL AMOUNT ENCLOSED (Registration Fee plus Guest Tickets): $________
PAYMENT INFORMATION: Payment in U.S. dollars must accompany this form.
| [ ] Check (payable to AGU) | OR | [ ] AMEX [ ] VISA [ ] MasterCard |
Cardholder's Name: _______________________________________________________________
Card No.: _______________________________________________ Exp. Date:_______________
Signature: _______________________________________________________________
Please indicate any special requests, needs, or restrictions, such as disabilities, or dietary restrictions.
COMPLETE THIS FORM AND RETURN BY MARCH 15, 1999 TO:
AGU-Atmospheric Sci. Chapman,
2000 Florida Ave., NW,
Washington, DC 20009 USA; Fax: +1-202-328-0566