Instructions: Due to credit card security reasons this form will not be made electronic this year. Please feel free to print this and submit the completed form by fax to (716) 852-4846 with a credit card payment or mail it to the address below accompanied by your payment.
| Family Name __________________________________ | First Name ____________________________________ |
| Dept _________________________________________ | Inst: _________________________________________ |
| Street/Box/Apt#: _______________________________ | City: _________________________________________ |
| St./Prov. ______________________________________ | Zip/Postal Code: _______________________________ |
| Country: ______________________________________ | Phone: _______________________________________ |
| Fax: _________________________________________ | E-mail: _______________________________________ |
____________________________________________
____________________________________________
____________________________________________
*Increment charged to non-member registration may be credited toward new member dues for 1998 by submitting a membership application form. Registration forms must be postmarked on or before June 1, 1998, 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 the ACA Headquarters. For cancellations received before June 1st, 20% of the total remittance will be deducted.Requests received between June 2 and June 20, 1998, will be honored minus 50% of the total remittance. Fees will not be refunded after June 20, 1998.
| Registration | By June 1st | After June 1st |
| ___ Regular Member | $225.00 | $300.00 |
| ___ Retired Member | $90.00 | $90.00 |
| ___ Student Member | $90.00 | $100.00 |
| ___ Non-member* | $300.00 | $375.00 |
| ___ Student Non-member* | $120.00 | $135.00 |
| ___ Accompanying | $65.00 | $75.00 |
| ___ 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 | ||
Workshop Registration
Saturday, July 18
___ Workshop I - Modeling Disordered Materials
$50 Students & $60 all others
___ Workshop II - Riding the Fence Between Large &
Small Molecules
$75 (Students
and all others) fee includes transportation and lunch
___ Workshop III - Data Handling for Small
Angle Scattering $50 Students & $60
all others
Workshop Total $_____________________
| Social Program | Will attend | Will not attend |
| Opening Reception, Saturday, July 18 | ____ | ____ |
| YSSIG Mentor Dinner, Sunday, July 19 | ____ | ____ |
| ___As a Mentor ___As a Mentee | ||
| Midweek Mixer, Monday, July 20 | ____ | ____ |
| Annual Banquet, Wednesday, July 23 |
| ___ $50 tickets | # of tickets___ |
| ___ $25 tickets | # of tickets___ |
Banquet Total $______________________
TOTAL REMITTANCE $_________________
Payment Method:
___ Check (drawn on U.S. bank only)
___Visa ___ MasterCard
Card Number
__/__/__/__/ - __/__/__/__/ - __/__/__/__/ - __/__/__/__
Expiration Date ___/___
Authorized
Signature of Card Holder
___________________________________________
All prices listed are in U.S. dollars and must be submitted in U.S. dollars. Make checks payable to ACA and mail 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 (716) 852-4846.