2000 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, 2000, 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, 2000, 20% of the total remittance will be deducted.
Requests received between June 2 and June 30, 2000, will be
honored minus 50% of the total remittance. Fees will not be
refunded after July 1, 2000. *Increment charged to non-member
registration may be credited toward new member dues
for 2000 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. 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 $225.00 $300.00
___Retired Member $90.00 $90.00 
___Student Member $90.00 $90.00
___Non-member* $300.00 $375.00
___Student Non-member* $114.00  $138.00
___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
 ___ WK01 SHELX $60.00
 ___ WK02 Making Technical Presentations $25.00
 ___ WK03 Cambridge Database $25.00

Workshop Total $________________

 Social Program

Will
attend

Will not
attend
Opening Reception  ____ ____
YSSIG Mentor/Mentee Dinner  ____ ____
YSSIG Mixer  ____ ____
Annual Banquet
# ___$40.00 ticket /#___ $20.00 student tickets (only students)
Indicate choice of entree:
_____Prime Rib _____Chicken Breast _____Vegetarian
Anniversary Cruise
#___ $30.00 ticket
Indicate choice of entree: _____ Walleye _____Prime Rib
_____Cornish Hen _____Vegetarian
 Accompanying Guests:    
Opening Reception # of tickets ____$30/each
YSSIG Mixer # of tickets ____$10/each
Banquet # of tickets ___$40/each
Entree: ___Prime Rib ___Chicken Breast ___Vegetarian
Anniversary Cruise # of tickets ___$30/each
Indicate choice of entree: ___ Walleye ___Prime Rib
___Cornish Hen ___Vegetarian

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

____________________________________________