28 – 31 October
REGISTRATION
To register send the completed registration form with remittance to Lesia Linkous, Division of Polymer Chemistry, Inc., Virginia Tech, 103 Surge Bldg, 0279, Blacksburg, VA 24061. Phone: 540-392-3042, Fax: 540-231-2588, E-mail: lesiar@vt.edu
The 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
__ $750 Member Registration
__ $800 Non-Member Registration
__ $225 Member Student Registration
__ $275 Non-Member Student Registration
__ $50 Late Fee (after September 27, 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
__ $750 Member Registration
__ $800 Non-Member Registration
__ $225 Member Student Registration
__ $275 Non-Member Student Registration
__ $50 Late Fee (after September 27, 2012)
Total Amount Due: $
Payment by: __ Check __ Credit Card
__VISA __MASTER CARD __AMEX
Exp. Date
Account #
Signature
