February 15 - 18, 2009Asilomar Conference Grounds
Pacific Grove, California USA
REGISTRATION
To register send the completed registration form with remittance to Lesia Linkous, Division of Polymer Chemistry, Inc., Virginia Tech, 410 Davidson Hall, M.C. 0279, Blacksburg, VA 24061. Phone: 540-231-3052, Fax: 540-231-2588, E-mail: lesiar@vt.edu
Click here for online registration.
Prof. Dr. Mr. Ms. Mrs. Miss
Name
Organization
Mailing Address
City State Zip
Country
Phone Fax
E-mail
__ $625 Member Registration
__ $675 Non-Member Registration
__ $125 Member Student Registration
__ $175 Non-Member Student Registration
__ $125 Accompanying Guest
Name:
__ $50 Late Fee (after January 8, 2009)
Total Amount Due: $
Payment by: __ Check __ Credit Card
__VISA __MASTER CARD __AMEX
Exp. Date
Account #
Signature
Name
Organization
Mailing Address
City State Zip
Country
Phone Fax
__ $625 Member Registration
__ $675 Non-Member Registration
__ $125 Member Student Registration
__ $175 Non-Member Student Registration
__ $125 Accompanying Guest
Name:
__ $50 Late Fee (after January 8, 2009)
Total Amount Due: $
Payment by: __ Check __ Credit Card
__VISA __MASTER CARD __AMEX
Exp. Date
Account #
Signature
