Omni Hotel San Diego 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: 540-392-3042, Fax: 540-231-2588, E-mail: lesiar@vt.edu
Registration form and bank transfer information 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
__ $725 Member Registration
__ $775 Non-Member Registration
__ $275 Member Student Registration
__ $325 Non-Member Student Registration
__ $50 Late Fee (after November 2, 2012)
Total Amount Due: $
Payment by: __ Check __ Credit Card
__VISA __MASTER CARD __AMEX
Exp. Date
Account #
Signature
