Name: ________________________________________________________________
Address - line 1: _________________________________________________________
Address - line 2: _________________________________________________________
City, State ZIP: __________________________________________________________
Telephone: (______)_______________ Ext.__________ FAX: (______)_____________
E-mail: ________________________________________________________________
Institution (to appear on your name tag): _______________________________________
I will do a "Take Five" presentation on ______ Friday afternoon, ______ Saturday morning.
| Description | Number | Unit cost | Amount |
|---|---|---|---|
| Faculty registration | $ 15 | ||
| Student registration | $ 5 | ||
| ISAAPT dues | $ 5 | ||
| Tour of Argonne National Laboratory | free | ---- | |
| "Make and Take" workshop (limit 20) | $ 20 | ||
| Friday evening banquet* | $ 10 | ||
| Total fees | ---- | ---- |
*The Friday banquet is available only to those who have registered by the April 12 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:
David Renneke
Department of Physics and Astronomy
Augustana College
Rock Island, IL 61201-2296
Voice: (309) 794-3403
FAX: (309) 794-7722
e-mail: phrenneke@augustana.edu
Last update: March 21, 1999