REGISTRATION






You can fill in this form by entering data in each text block.
To submit, please print this page and mail it with your payment.

Your Name:
Your Organization:
Address:
Telephone:
 FAX:
 E-mail:
Point of Contact:
Telephone:
 FAX:
 E-mail:

Conference Fees:

Professional:
If paid before March 1, 2000 . . . . $350
otherwise . . . . $390
Student: . . . . $250
Additional Banquet Tickets:
Your registration fee includes one ticket.
Tickets for guests and spouses are $40 each.

I am registering as a Professional or Student

I will need additional Banquet Tickets.

If paying by Credit Card:

    (check one:)

    ______ VISA

    ______ MasterCard/EuroCard

    NOTE: We cannot process purchase orders or foreign currency.
    We cannot process American Express credit cards.

     Card Number: ____________________________________

     Expiration Date: ________________________________

     Cardholder Name: ________________________________

     Card Billing Address (if different from above):

     ___________________________________________

     ___________________________________________

     ___________________________________________

     Signature: ______________________________________

     Date: ___________________________

Please remember to sign this form before sending.


Make checks payable to:
Johns Hopkins University Applied Physics Laboratory
 
Mail this form and payment to:
JHU/APL
Diana Whitman, 4-278
11100 Johns Hopkins Road
Laurel, MD 20723-6099

Please remember to make your hotel reservations.