Asilomar 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, 103 Surge Bldg., 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
__ $675 Member Registration
__ $725 Non-Member Registration
__ $175 Member Student Registration
__ $225 Non-Member Student Registration
__ $50 Late Fee (after January 8, 2013)
Total Amount Due: $
Payment by: __ Check __ Credit Card
__VISA __MASTER CARD __AMEX
Exp. Date
Account #
Signature
