Rationale
North American Site
Europe Site
South America Site
About the site
Local Organization
Important Dates, Fees, and Deadlines
Registration
Pre-arrival Form
Accommodations and Transportation
Side Excursions
Exhibitors / Sponsors Information
Exhibitors Contract
Exhibitors Registration
Contact us
NORTH AMERICAN SITE
We prefer that you submit your registration online, however you may also complete this form, print it and mail it or fax it.
GENERAL INFORMATION
Salutation: Select One Dr. Mr. Ms.
Last Name: First Name: Middle Initial:
Institution:
Department: Job Title:
Address:
City: State: Postal Code: Country Email:
Telephone: Fax:
How did you first hear about the conference? Select One Symposium mailing E-mail announcement Symposium website Colleague NSTA Reports NSTA Conferences Other
REGISTRATION TYPE
Select One Regular Registration ($375 on or before April 15, 2006) Presenter (includes students presenting regular papers) ($375 on or before April 15, 2006) Student Poster Presenter ($100 on or before March 30, 2006) Student not presenting a paper ($100 on or before March 30, 2006) Virginia One-Day Registration for Friday ($100 on or before March 30, 2006) Virginia One-Day Registration for Saturday ($100 on or before March30, 2006) Late Registration ($450 After March 30, 2006) Guest (for Saturday banquet only $40) Saturday banquet ($40)
MENU TYPE (Please note, this question is asked to provide us with an indication of quantities.)
Friday banquet Select One Regular Vegetarian
PAYMENT INFORMATION
Registration Fee $
Banquet $
Total $
Payment Method: SELECT ONE CHECK VISA MASTERCARD DISCOVER AMERICAN EXPRESS BANK WIRE TRANSFER OTHER If other, please specify:
Credit Card Number: Expiration Date:
Authorization Code (extra 3 digits located in the signature box on the back of Mastercard, Visa and Discover and on the front beneath the regular card number on AMEX.):
NOTE: All payments should be made in US dollars.
Please type your name as it appears on your credit card (required for credit card purchases):
Checks should be payable to VCU Physics Department, Federal ID # 54-6001758 and mailed to: Physics Department, Virginia Commonwealth University Attn: Barbara Martin 1020 West Main, Richmond VA 23284-2000
