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Name: ___________________________Badge Name: ___________________________________
Address:
________________________________________________________________________________
City: _________________________ State/Province: _______ Zip/Postal Code: _______
Country: __________________ Phone: _____________________ Fax: __________________
E-mail:
________________________________________________________________________________
TRAVEL ITINERARY:
Airport: _________________________ Airline/Flight No.: _______________________
Arrival Date/Time: ______________________________
Departure Date/Time: _______________________________
___ I want to reserve a seat on a vanpool.
___ I plan to rent a car.
___ I'm willing to carpool.
Other Information:
_______________________________________________________________________________
REGISTRATION FEES:
There are no one-day pro-rated registration fees. Participant
registration fees cover admission to all scientific sessions,
refreshment breaks, reception, barbecue, Cruise and Rim field trips.
All participants must register in advance by August 1, 1996.
____Scientists $260.00
____Students $145.00
ACCOMMODATIONS: Accommodations will be in double rooms with 2 queen beds.
Please indicate your gender and smoking preference for the purpose of
roomate matching*.
___ Male ___ Female ___ Smoker ___ Non-Smoker
___ Room Deposit $ 20.00 (non-refundable)
BOX LUNCHES: For your convenience, you may wish to order
box lunches which will be delivered to the meeeting area
(bag lunches will be provided on field trip days)*.
___ Thursday ___ Friday ___ Saturday ___ Sunday
_____ days x $12.00 = $_____
OPTIONAL FIELD TRIP (select only one):
Fee includes transportation and refreshments.
___ Iron Mountain $ 25.00
___ Lassen Park $ 25.00
* Please indicate any special requests, needs or restrictions,
such as disabilities, dietary restrictions, or roommate preferences.
___________________________________________________________________________
TOTAL (Registration,
Accommodations, Box Lunches,
and 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 AUGUST 1 TO:
AGU-Crater Lakes, 2000 Florida Ave., NW
Washingon, DC 20009
Fax: 202-328-0566
E-mail complete registration information to
awhite@agu.org .
NOTE: Fax or e-mail registrations must include credit card
payment.
General Release and Save Harmless Waiver
The undersigned does hereby assume any and all risks involved in my participation in the Crater Lake Boat Cruise Field Trip offered through the American Geophysical Union (AGU) for the Chapman Conference on Crater Lakes, Terrestrial Degassing, and Hyper-acid Fluids in the Environment, 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
General Release and Save Harmless Waiver
The undersigned does hereby assume any and all risks involved in my participation in the Iron Mountain, California Field Trip offered through the American Geophysical Union (AGU) for the Chapman Conference on Crater Lakes, Terrestrial Degassing, and Hyper-acid Fluids in the Environment, 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
General Release and Save Harmless Waiver
The undersigned does hereby assume any and all risks involved in my participation in the Lassen Park, California Field Trip offered through the American Geophysical Union (AGU) for the Chapman Conference on Crater Lakes, Terrestrial Degassing, and Hyper-acid Fluids in the Environment, 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
General Release and Save Harmless Waiver
The undersigned does hereby assume any and all risks involved in my participation in the Crater Lake Rim Field Trip offered through the American Geophysical Union (AGU) for the Chapman Conference on Crater Lakes, Terrestrial Degassing, and Hyper-acid Fluids in the Environment, 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
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