Online Registration Form

Fall Meeting of the Illinois Section of AAPT
October 15-16, 2004 at Bradley University, Peoria, Illinois
and October 14-15, 2004 at Illinois Central College, East Peoria, Illinois
Note: Please do not put commas inside any of the boxes.
First name   Last name  
Mailing address - line 1 
Mailing address - line 2 
City  State   ZIP code 
 

Note: Include the area code; use hyphens.
Telephone   Ext   FAX 
E-mail 
Institution (to appear on your name tag)  
 
I would like to do a "Take Five" (e.g. a new demo, announcement,..)  
Title for my Take Five  
Registration Fees
Note: Please do not put dollar signs inside any of the boxes.
Description No. Unit cost Amount Choice of food
Faculty registration $18  
Student registration $5
Illinois section dues $5
Pre-Session Workshop at ICC, Thurs. & Friday
   W1. "Repairing the Ill. High School Physics Pipeline"		 Faculty
Student

$10
$5

Workshop - Friday, 10:00 to noon
    W2. "Loop 'em and Launch 'em with CPO Science Physics"		 free  
Workshop - Friday, 10:00 to noon
    W3. "Simple Experiments in Physics"		 free    

Note:  The deadline for meal reservations was Friday, October 8
Friday evening banquet *  The entree choices are apple-pecan chicken breast, stuffed pork chop, and vegetable lasagna.  The deadline for meal
reservations is past.
Saturday noon box lunch *  The sandwich choices are turkey and ham.
Total fees      
* The meals are available only to those who have registered by the October 8 deadline.  All registration fees are due the day of the meeting. Checks should be made payable to ISAAPT.
Depending on your Internet connection and how busy the Web server is, there may be a short delay after you click on "Send Registration Now" and before you receive the automatic acknowledgement.
    

Webmaster: David Renneke - phrenneke@augustana.edu, (309) 794-3403
Last update: October 10, 2004

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