The Flamingo, Las Vegas, Nevada USA
REGISTRATION
To register, send the completed registration form with remittance to Lesia Linkous, Division of Polymer Chemistry, Inc., Virginia Tech, 103 Surge Bldg., M.C. 0279, Blacksburg, VA 24061. Phone: 540-392-3042, Fax: 540-231-2588, E-mail: lesiar@vt.edu
registration form is available by clicking here
or simply copy the below information, place it in the body of an email, and send to Lesia Linkous at lesiar@vt.edu
Prof. Dr. Mr. Ms. Mrs. Miss
Name
Organization
Mailing Address
City State Zip
Country
Phone Fax
E-mail
__ $725 Member Registration
__ $775 Non-Member Registration
__ $225 Member Student Registration
__ $275 Non-Member Student Registration
__ $50 Late Fee (after September 12, 2012)
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
__ $725 Member Registration
__ $775 Non-Member Registration
__ $225 Member Student Registration
__ $275 Non-Member Student Registration
__ $50 Late Fee (after September 12, 2012)
Total Amount Due: $
Payment by: __ Check __ Credit Card
__VISA __MASTER CARD __AMEX
Exp. Date
Account #
Signature
