Registration Form

44th Conference on Bioassay, Analytical, and Environmental Radiochemistry

Please complete the following information and mail or fax this form with applicable registration fees to:
44th BAER Conference
P.O.Box 2078
Carlsbad, NM 88221-2078
Attn: Dr. C. F. Wu
Tel: 505-234-8384, Fax: 505-885-4562

Name:

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(Last)

(First)

(MI)


Organization:


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Address:

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City, State, Zip:

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Phone/Fax/E-mail:

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Arrival/Departure Dates:

 

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Accompanying Person(s):

 

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For SNL & WIPP tours only:

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(Social Security Number)

(Date of Birth)

(Citizenship Status)

Registration Fee(s): $120 before 8/1/98, $140 after 8/1/98, $150 after 11/1/98, $75 for accompanying person(s).
I plan to attend the following events:

___ Welcome Reception at the Marriott Hotel (11/16/98, 5-8 PM) - No charge
___ Conference Dinner & Entertainment (11/18/98, 5-9PM) - No charge
___ Tour of Sandia National Labs (11/19/98, 1-4PM) - No charge
___ Tour of the WIPP Facility (11/20/98, 6AM-7PM) - $75/person, includes air transportation
For social tours see the latest news on the conference web page.

Total payment: $_______________ (Registration fee(s) + Other applicable fees)

__ Check Enclosed __ Credit Card (__Visa __Master Card __American Express)

Card Number:______________________ Expiration Date:___________

Card Holder's Name: _____________________________ Signature:_________________________________