Mail form with payment to:
1995 Spring Meeting,
American Geophysical Union,
2000 Florida Avenue, NW,
Washington, DC 20009.
All fees are in U.S. dollars.
This form can be printed or saved electronically and mailed, faxed, or e-mailed to AGU. Please type or print clearly. To avoid duplicate charges, submit only one form per attendee. You may register electronically or by fax with credit card.
Family Name_________________ MI_____Given Name___________________ Name for Meeting Badge____________________________________________ Organization/Company _____________________________________________ Mailing Address___________________________________________________ City___________State/Province_________Zip/Postal Code_____________ Country_______________Internet E-Mail_____________________________ Telephone Number____________________Fax___________________________ Check as appropriate ___AGU Member ___Non-member AGU Membership Number: ________________ If you are an AGU Member, please check your primary affiliation: AS__ G__ GP__ H__ OS__ P__ S__ SA__ SH__ SM__ T__ V__ Check below if you are registering as a cooperating society member: ___ AMS American Meteorological Society ___ ASP American Society of Photogrammetry and Remote Sensing ___ ACSM American Congress on Surveying and mapping ___ CGU Canadian Geophysical Union ___ EGS European Geophysical Society ___ UGM Union Geofisica Mexicana ___ Check here if you are disabled and/or require special services. Attach a written description of your needs. A staff member will contact you to discuss measures AGU can take to accommodate you.
REGISTRATION FEES:(Rates are only applicable if registration form along with payment is received at AGU by April 28, 1995. Late fees will automatically be charged after this date. Members of cooperating societies should register at member rates). One Day More than One Day Regular Member ____$ 90.00 ____$180.00 Student Member ____$ 35.00 ____$ 70.00 Retired Senior Member* ____$ 35.00 ____$ 70.00 Non-Member ____$110.00 ____$220.00 Student Non-Member ____$ 55.00 ____$110.00 * Age 65 or older and retired from full-time employment TOTAL REGISTRATION FEE: $______ Please check the days you plan to attend: ___ Mon ___ Tues ___ Wed ___Thur ___Fri SECTION LUNCHES: (Tuesday May 30) If you wish to attend a section lunch, check the appropriate box below and indicate the number of tickets. Events are open to all participants. ___ Atmospheric Sciences ___ Hydrology ___ Planetology ___ Seismology ___Space Physics and Aeronomy ___ Ocean Sciences $17.00 each x ____ tickets = $ _____ HONORS BANQUET: (Wednesday, May 31) $40.00 each x ____ tickets = $ _____ TOTAL AMOUNT ENCLOSED: $ _____ (Registration, Section Events, Banquet)
PAYMENT INFORMATION:Make Checks payable to AMERICAN GEOPHYSICAL UNION By ___ check or ___ credit card. If paying by credit card, please complete the following: Name on the credit card (Please Print)______________________________ Card used (check) Visa___ Mastercard___ American Express___ Credit Card Number_______________Expiration Date__________ I authorize you to charge my credit card account for expenses associated with the 1995 Spring Meeting. Signature of card holder:____________________Date:_______________
RETURN FORM TO:1995 Spring Meeting Fax: 1-202-328-0566 c/o American Geophysical Union Phone: 1-202-462-6900 outside the U. S. or 2000 Florida Avenue, N.W. toll free in U.S. and Canada 1-800-966-2481 Washington, DC 20009, USA e-mail: email@example.com PREREGISTRATION DEADLINE: APRIL 28, 1995
Return to Meetings