Regular Mail or FAX - Registration Form

Spring Meeting of the Illinois Section of AAPT, Apr. 23-24, 2004, University of Illinois, Urbana-Champaign, Illinois

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.

The title of my Take Five presentation is: __________________________________________________

The Student Research Symposium needs a few judges. Could you help? ______________________
Those who say "yes" will be contacted in advance with instructions. Thank you.

 
Description Number Unit cost Amount
Faculty registration   $18  
Student registration   $ 5  
Illinois section dues   $ 5  
Workshop  W1 - "Using Classroom Electronic Polling Systems to Increase Student Engagement", Friday 10:30-12:00   free  
Workshop  W2 - "Tycho: Enhancing Your Course with Web Technology", Friday 10:30-12:00   free  
Workshop  W3 - "Polarization and Refraction: Lab Experiences for the Introductory Course", Friday 10:30-12:00   free  
Workshop  W4 - "Simple Experiments in Physics", Friday 10:30-12:00   free  
* Friday evening banquet. Circle your choice of entree: 1. chicken marsala, 2. steak diane, 3. goat cheese filled portabella mushroom cap   $19  
* Saturday noon lunch. Circle your choice of sandwich:  turkey, ham, roast beef, veggie   $ 7.50  
Total fees  

* The meals are available only to those who have registered by the April 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:  Cindy Hubert, Physics Department, University of Illinois, 1110 West Green Street, Urbana, IL 61801-3080.  Phone: 217-244-6225.  FAX: 217-333-9819.

Last update: February 20, 2004

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