DPF96 Registration

DPF96 Registration Form

(First Name, Initial, Last Name)

(Institution)

(Mailing Address)

(City, State/Country, ZIP/Postal Code)

(Email address)

(Telephone, Fax)

(Names and ages - if under 18 - of accompanying persons)

Registration Information:

Pre-registration (with payment before 4 July 1996)
APS Member: $260
Non-member: $320
Graduate Student, Retired or Unemployed*: $50

Registration (after 4 July 1996)
APS Member: $320
Non-member: $380
Graduate Student, Retired or Unemployed*: $75

* these registration categories do not include Conference Proceedings or tickets to the Social Event or Conference Dinner.

Members of the European, Russian and Japanese Physical Societies may register at APS member rates.

Optional Visit to Soudan Underground Physics Laboratory
Please check if you are interested in participating in a tour of the Soudan Underground Physics Laboratory, 220 miles north of Minneapolis, on Friday, August 16, 1996 ($25 charge covers travel and lunch).

Payment options

Check - please print out this form and mail it to the address below, enclosing your check (drawn in U.S. dollars on a U.S. bank and payable to the Regents of the University of Minnesota).
I will pay at a future time before or at the DPF96 Conference. (Pre-registration discount does not apply unless payment is received by July 4, 1996.)
Mastercard or Visa - fill in card details below for electronic submissions, or mail a printed copy of the form to the address below. Note: transmission is not secure and is at your own risk!

(Credit Card Type, Card Number, Expiration Date)

(Authorized Signature)

Please return this form (by 4 July 1996 for pre-registration discount) to:
DPF96, School of Physics and Astronomy, University of Minnesota,
116 Church St. S.E., Minneapolis, MN 55455, U.S.A.
Email Sandra Smith, phone: (612) 624-7886, fax: (612) 624-4578
Please note: No refunds after August 1, 1996. Refunds before that date will be charged a $25 handling fee.

Sponsored by the University of Minnesota, the University of Wisconsin and the U.S. Department of Energy.
Comments/questions to: allan@mnhep1.hep.umn.edu (web), or dpf96@mnhep1.hep.umn.edu (DPF)
The URL of this page is http://www.hep.umn.edu/dpf96/regform.html
Last Updated: 13 July 1996