Regular Mail or FAX - Registration Form

Spring Meeting of the Illinois Section of AAPT, April 8-9, 2005
Southern Illinois University Edwardsville, Edwardsville, 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  
K12 faculty registration   free  
Student registration   $ 5  
Illinois section dues   $ 5  
Workshop  W1 - "Waves and Color - Mostly on the Cheap", Friday 9:00-12:00   $15  
Workshop  W2 - "Photoelectric Effect", Friday 8:00-12:00   $10  
Workshop  W3 - "Astronomy Inquiry Activities", Friday 9:00-12:00   free  
* Friday evening banquet. Circle your choice of entree: 1. chicken breasts, 2. prime rib, 3. portabella mushroom   $16  
* Saturday noon lunch. Circle your choice of sandwich:  turkey, ham, roast beef, veggie   $ 7  
Total fees  

* The meals are available only to those who have registered by the April 1 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:  Kimberly Shaw, Department of Physics, Southern Illinois University Edwardsville, Edwardsville, IL 62026, Phone: 618-650-2472, Fax: 618-650-3556.

Last update: March 22, 2005

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