The Geomorphic and Climatic Significance of Rock Glaciers

August 23-28, 1996
DEADLINE: AUGUST 7, 1996

 
Name:       _____________________________________________

Badge Name: _____________________________________________ 

Address:    _____________________________________________
  
            _____________________________________________

City:       _____________________________________________

State/Province: _______   Zip/Postal Code: _________________

Country:    _________________________  

Phone: __________________________ Fax: __________________________

E-mail: ______________________________________________


Do you need to be picked up at the Cody Airport on August 23?

   ___  YES   ___  NO 

Arrival Date: ___________________________ Time:________________ 

Airline/Flight No.: _____________________

Departure Date: _________________________ Time: _______________

If you are not planning to fly into Cody Airport,
 please indicate your travel plans:

_____________________________________________________________________________

REGISTRATION FEES: There are no one-day pro-rated registration fees. Participant registration fees cover admission to all scientific sessions, refreshment breaks, accommodations, meals, and the Galena Creek field trip. All participants must register in advance by August 7, 1996. There will be no on-site registration for this conference.

            ___ REGISTRATION FEE $265.00

ACCOMMODATIONS/MEALS: Accommodations will be in cabins which sleep up to six people. Please indicate your gender and smoking preference for rooming purposes. Meals will be served in the dining room of the main lodge (bag lunch on field trip days); cooking in cabins is prohibited.

    ___ Male ___ Female ___ Smoker ___ Non-Smoker

___ Please indicate any special requests, needs or restrictions, such as disabilities, dietary restrictions, or roommate preference:

________________________________________________________________________________________________

RED LODGE, MONTANA FIELD TRIP (OPTIONAL): Includes additional accommodations/meals.

I plan to leave Cody:

___ Wednesday, August 28 (after 6pm)$16.50

___ Thursday, August 29    $26.75

TOTAL REGISTRATION FEE        

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 AUGUST 7 TO:
AGU-Rock Glaciers, 2000 Florida Ave., NW, Washingon, DC 2000
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.

The undersigned does hereby assume any and all risks involved in my participation in the Red Lodge, Montana Field Trip offered through the American Geophysical Union (AGU) for the Chapman Conference on the Geomorphic and Climatic Significance of Rock Glaciers, 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

The undersigned does hereby assume any and all risks involved in my participation in the Galena Creek Rock Glacier Field Trip offered through the American Geophysical Union (AGU) for the Chapman Conference on the Geomorphic and Climatic Significance of Rock Glaciers, 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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