Chapman Conference on Magnetic Storms
February 12 - 16, 1996.
Pasadena, California
REGISTRATION FORM DEADLINE: December 29, 1995
Use one form per registrant. Please make check payable to the American Geophysical Union.
FULL NAME ____________________________________________________________________
NAME FOR BADGE _______________________________________________________________
AFFILIATION __________________________________________________________________
ADDRESS ______________________________________________________________________
CITY ____________________STATE ___________________ZIP/POSTAL CODE ____________
HOME ADDRESS _________________________________________________________________
(REQUIRED FOR CLEARANCE OF FOREIGN NATIONALS)
COUNTRY ____________________________CITIZEN OF _______________________________
TELEPHONE _______________ FAX_________________ EMAIL _________________________
I am giving a paper entitled:_________________________________________________
______________________________________________________________________________
I am a student working on a Masters/PhD degree under Professor:_______________
My Thesis topic is:___________________________________________________________
I plan on attending the Big Bear Lake Excursion on Saturday, February 17: yes [ ] no [ ]
REGISTRATION FEES:
There are no one-day pro-rated registration fees. Participant registration fees
cover admission to all oral and poster sessions and the conference social events.
Before 12/29/95 After 12/29/95
Meeting Participant: $255.00 Meeting Participant: $295.00 $ ________
Student Participant: $ 90.00 Student Participant: $130.00
GUEST FEES:
Korean Barbeque Banquet $25.00 x ______(guests) $ ________
TOTAL AMOUNT PAID: $ ________
PAYMENT INFORMATION:
Charge to: [ ]MasterCard [ ]AmEx [ ]Visa
Card Number _________________________________ Expiration Date ________________
Signature _________________________________________
(Print name as it appears on the card)
Other Methods of Payment:
[ ]Check Enclosed [ ]Bank Draft
If you are disabled and require special assistance please provide a list of your special needs.
______________________________________________________________________________
Please send this information back by e-mail, fax, or regular mail to:
Chapman Conference on Magnetic Storms
AGU 2000 Florida Avenue, NW
Washington, DC 20009
Phone: 202-462-6900 ext. 382
Fax: 202-328-0566 (attention Kristen Hansen)
E-mail: khansen@agu.org
