Regular Mail or FAX - Registration Form

Fall Meeting of the Illinois Section of AAPT
October 23-24, 1998
Highland Community College
Freeport, Illinois

Name:  ________________________________________________________________

Address - line 1:  _________________________________________________________

Address - line 2:  _________________________________________________________

City, State ZIP: __________________________________________________________

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

E-mail:  ________________________________________________________________

Institution (to appear on your name tag):  _______________________________________

   Workshop reservation (no charge): W1 - Physical Science (1:15 - 4:00)    ____________
W2 - Pasco Demos (1:15 - 2:30)    ______________
W3 - Pasco Demos - repeat (2:45 - 4:00)   ________

I will do a "Take Five" presentation on ______ Friday afternoon,  ______ Saturday morning.

Registration Fees

Description Number Unit cost Amount
ISAAPT dues  
$ 5
 
Student registration  
$ 5
 
Faculty registration  
$ 12
  
Friday evening banquet*  
$ 15
  
Saturday noon lunch  
$ 5
  
Total fees
----
----
  

*The Friday banquet is available only to those who have registered by the October 16 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:

Eric Peterson
Department of Natural Science
Highland Community College
2998 W. Pearl City Road
Freeport, IL 61032
FAX: (815) 235-6130 Last update: September 30, 1998