May 20 - 23, 2013

Safety Harbor Hotel and Conference Center

Safety Harbor, Florida  USA


REGISTRATION

Register

 

BY EMAIL, FAX, PHONE, MAIL

 

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                                             
E-mail                                                                                                   
__   $600 Member Registration
__   $650 Non-Member Registration
__   $250 Member Student Registration
__   $300 Non-Member Student Registration

__    $50 Late Fee (after April 17, 2013)
Total Amount Due:  $                                                                          

Payment by:          __  Check              __  Credit Card

          __VISA              __MASTER CARD             __AMEX  

Exp. Date                                                                                               
Account #                                                                                             
Signature