2001 ACA Registration Form


Family Name: ___________________________________

First Name: _____________________________________

Dept: __________________________________________

Inst: ___________________________________________

St: ____________________________________________

City: __________________________________________

St/Prov: _____________ Zip/Postal Code: ____________

Country: _______________________________________

Phone: _________________________________________

Fax: ___________________________________________

E-Mail: ________________________________________

*Registration forms must be postmarked or received on or
before June 1, 2001, to be eligible for the advance registration
fees. After June 1, registrations will be accepted at the higher
rate. On-site registration will be available at the higher rate.
Cancellation and requests for refunds should be made in writing
to ACA Headquarters. For cancellations received before
June 1, 2001, 20% of the total remittance will be deducted.
Requests received between June 2 and June 30, 2001, will be
honored minus 50% of the total remittance. Fees will not be
refunded after July 1, 2001. *Increment charged to non-member
registration may be credited toward new member dues
for 2001 by submitting a membership application form.

All prices listed are in U.S. dollars and must be submitted in
U.S. dollars. Purchase orders will not be accepted. Only
U.S. checks will be accepted. ACA, EIN 22-6075182
Please make checks payable to:
ACA Meeting Registration
P.O. Box 96, Ellicott Station
Buffalo, N.Y. 14205-0096 USA
Forms submitted via fax must include VISA or MasterCard
payment information. Fax to (716) 852-4846.
Registration  Before
June 1		 After
June 1 
___Regular Member $250.00 $325.00
___Retired Member $100.00 $100.00 
___Student Member $95.00 $95.00
___Non-member* $325.00 $400.00
___Student Non-member* $120.00  $144.00
___One-day Member $150.00 $225.00
 __S __M __T __W __Th
___One-day Non-member $195.00 $270.00
 __S __M __T __W __Th
Registration Total $________________

 Workshops      $60 - registered students, $70 - all others
 ___ WK01 Anomalous Scattering Methods
 ___ WK02 Real-Space Pair Distribution Methods
 ___ WK03 Atomic Force Microscopy
 ___ WK04 Neutron Diffraction

Workshop Total $________________


 Social Program

Will
attend

Will not
attend
July 21 - Opening Reception   ____ ____
Extra tickets for opening reception $30. each #____  
July 22 - YSSIG Mentor/Mentee Dinner
 Mentee $10 ticket - #____  
 Mentor $10 ticket - #____  
July 23 - YSSIG Mixer   ____ ____
Extra tickets for Mixer $10. each #____  
July 25 - Awards Banquet
Regular ticket - $55 each #____  
Student ticket - $20 each #____  
Indicate choice of entree:

_____Beef _____Chicken _____Vegetarian

July 26 - Getty Center Tour
Bus ticket - $10 each #____  


Social Total $_________________


TOTAL REMITTANCE $_________________


Payment Method

___Check (drawn on U.S. bank only) ___ VISA ___MasterCard
Card Number

__/__/__/__-__/__/__/__-__/__/__/__-__/__/__/__

Good thru/Expiration date __/__/
Authorized Signature of Card Holder

____________________________________________