'97 ACA REGISTRATION FORM

Family Name_________________________________________
First Name___________________________________________
Dept. _______________________________________________
Inst. ________________________________________________
St.__________________________________________________
Box/Apt.# ___________________________________________
City ________________________________________________
St/Prov.______________ Zip/Postal Code _______________
Country _____________________________________________
Fax ________________________________________________
E-mail ______________________________________________

Name(s) of Accompanying Guest(s) (non-scientist)

_________________________________________________
_________________________________________________
_________________________________________________

*Increment charged to non-member registration may be credited toward new member dues for 1997 by submitting a membership application form. Registration forms must be postmarked or faxed (716-852-4846) on or before June 1, 1997 to be eligible for reduced registration fee. On site registration will be accepted at the higher rate. Cancellations and requests for refunds should be made in writing to ACA Headquarters. For cancellations received before June 1, 20% of the total remittance will be deducted. Requests received between June 2 and June 20, 1997 will be honored minus 50% of the total remittance. Fees will not be refunded after June 20, 1997.

Registration:

__Regular Member - $205 (after June 1st - $275)
__Retired Member - $ 75 (after June 1st - $ 75)
__Student Member - $ 75 (after June 1st - $ 85)
__Non-member* - $275 (after June 1st - $345)
__Student Non-member* - $105 (after June 1st -$120)
__Accompanying - $ 50 (after June 1st -$ 60)
__One-day Member - $130 (after June 1st -$200)
circle one: S M T W Th F
__One-day Non-member - $175 (after June 1st -$245)
circle one: S M T W Th F

Registration Total $_______________

Workshop Registration - Saturday, July 19:

Measuring Electron Density Distributions
__Workshop I - $50 Students $60 all others
A Decade of Structure Based Drug Design
__Workshop II - $50 Students $60 all others
Research Opportunities at Third Generation Synchrotron Sources
__Workshop III - $25 Students $30 all others

Workshop Total $________

Social Program:

Opening Reception - Saturday, July 19: # attending ___
Annual Banquet - Thursday, July 24:
$50 ticket # of tickets ____

Banquet Total $________

YSSIG Activities:

Mentor Dinner - Sunday, July 20

Would you like to take part in the YSSIG Mentor Dinner?
__No
__Yes, as a mentor
__Yes, as a mentee

YSSIG Mixer - Tuesday, July 22

__Will attend
__Will not attend

TOTAL REMITTANCE $___________

All prices listed are in U.S. Dollars and must be submitted in U.S. Dollars.
Make checks payable to the ACA and mail to:

ACA Meeting Registration
P.O. Box 96, Ellicott Station
Buffalo, NY 14205-0096
USA

Fax or E-mail credit card payments to:

Fax: 716-852-4846
E-mail: aca@hwi.buffalo.edu

Payment Method

__Check (drawn on U.S. bank only)
__VISA
__MasterCard

Card
Number __/__/__/__ - __ /__/__/__ - __/__/__/__ - __/__/__/__
Expiration Date _____________
Authorized Signature of Card Holder

___________________________________________