Registration Form

Name___________________________________________Title_________________
Company Name_______________________________________________________
Mailing Address___________________________________Mail Stop:____________
City______________________________State______________Zip______________

Telephone_________________________Fax________________________________
E-Mail Address________________________________________
Web Address__________________________________________

Security Information

US Citizen: Yes____ No____

If No, please fill in the below information. Because this is a Sandia Laboratory sponsored event, DOE requires the below information from non-United States citizens. No other action is required.

Full Name (including middle initial):____________________________
Date of Birth______________________________________________
Place of Birth______________________________________________
Current Citizenship:_________________________________________

Please Indicate Participation

Short Course,Monday October 2nd, Marriott Hotel

I will attend: YES NO

Poster Session: Tuesday Evening, October 3rd, Aquarium of America

I will attend: YES NO

Guest(s) will attend: $25 per person (12 Under 1/2 price, toddlers/infants free) YES NO

Name of Guest(s):____________________________

I will have an entry(s) for the Poster Session:

YES

NO

If yes, how many entries?__________________

I will have an entry(s) for the Vendor Exhibit:

YES

NO

Banquet and Awards - Marriott Hotel

Wednesday Evening, October 4th

I will attend: YES NO

Guest(s) will attend: $50 per person : (12 under 1/2 price, toddlers/infants free) YES NO

Name of Guest(s):____________________________

Registration Fees

MEETING COSTS:

$285 BEFORE SEPTEMBER 4, 2000
$325 AFTER SEPTEMBER 4, 2000
$80 Student Registration with Student ID

REGISTRATION:

Full Registration @ $285/$325 Per Attendee _________

Student Registration @ $80 per Attendee _________

Short Course @ $100 per Attendee _________

NOT COVERED IN REGISTRATION FEE

Guest(s) attending Poster Session @ $25/person (12 under $12.50, infants free) _________

Guest(s) attending Banquet @ $50/person (12 and under $25, infants free) _________

TOTAL AMOUNT ENCLOSED
_________

____VISA _____MasterCard _____AmEx (Check One)

___________________________________ ____________________________________

Card Number Expires

_________________________________________________________
Signature

MAKE CHECKS or MONEY ORDERS PAYABLE TO:
SANDIA NATIONAL LABORATORIES

MAIL TO: Tammy Eldred, Conference Coordinator
PO Box 5800, MS0833
Albuquerque, NM 87185-0833

Office: 505-844-0180
Fax: 505-844-8251 or 505-844-8081
Email: tjeldre@sandia.gov

Registration - Sandia Laboratories Participants Only

___________________________________ ____________________________________

Project/Task Number (Active) Project Manager Approval Signature

Special Needs

Please indicate here if you require special accessibility or accommodations at this meeting. My requirements are: (e.g. vegetarian, disability accommodations, audio/visual requirements for speakers, etc.)
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

For Registration Information
Tammy Eldred, Conference Coordinator (Mail Stop: 0833)
Office: 505-844-0180 Fax: 505-844-8251 Email: tjeldre@sandia.gov

Short Course,Monday October 2nd, Marriott Hotel
I will attend:	YES	NO
Poster Session: Tuesday Evening, October 3rd, Aquarium of America
I will attend:	YES	NO
Guest(s) will attend: $25 per person (12 Under 1/2 price, toddlers/infants free)	YES	NO
Name of Guest(s):____________________________
I will have an entry(s) for the Poster Session:	YES	NO
If yes, how many entries?__________________
I will have an entry(s) for the Vendor Exhibit:	YES	NO
Banquet and Awards - Marriott Hotel
Wednesday Evening, October 4th
I will attend:	YES	NO
Guest(s) will attend: $50 per person : (12 under 1/2 price, toddlers/infants free)	YES	NO
Name of Guest(s):____________________________

Full Registration @ $285/$325 Per Attendee	_________
Student Registration @ $80 per Attendee	_________
Short Course @ $100 per Attendee	_________
NOT COVERED IN REGISTRATION FEE
Guest(s) attending Poster Session @ $25/person (12 under $12.50, infants free)	_________
Guest(s) attending Banquet @ $50/person (12 and under $25, infants free)	_________
TOTAL AMOUNT ENCLOSED	_________

___________________________________	____________________________________
Card Number	Expires

___________________________________	____________________________________
Project/Task Number (Active)	Project Manager Approval Signature