Regular Mail or FAX - Registration Form

Fall Meeting of the Illinois Section of AAPT
October 13-14, 2000, Southern Illinois University at Edwardsville
Edwardsville, Illinois 62026-1654

Name:  ________________________________________________________________

Address - line 1:  _________________________________________________________

Address - line 2:  _________________________________________________________

City, State ZIP: __________________________________________________________

Telephone: (______)_______________ Ext.__________ FAX: (______)_____________

E-mail:  ________________________________________________________________

Institution (to appear on your name tag):  _______________________________________

I would like to do a "Take Five" (e.g. a demo, announcement,...) on ___ Fri. afternoon,  ___ Sat. morning, ___ either day.           

The title of my Take Five presentation is: _______________________________________________

+ We are pleased that SIUE is providing supplementary funds to cover some of the expenses for registration, the banquet, and the box lunches.  Normally the banquet and social time would be $24.

* The Friday banquet and the Saturday noon box lunch are available only to those who have registered by the October 11 deadline.  Please make your check payable to ISAAPT and include it with the registration sent via US Mail.  If registering by FAX or online, the registration amount will be due upon arrival.  Please return this registration form to:

Last update: October 9, 2000