| Mr. Ms.Dr.Prof. | (Check all that apply.) |
| Name | Telephone | ||||
| Title | Fax |
| Organization |
| Address | |||
| Address |
| City/Town | State/Province |
| Zip/PostalCode | Country |
Select Course or Courses (click to activate checkbox; all fees in US dollars):
| Course 1 - $650 | Nanoparticle Synthesis- Thursday, March 4, 2004 |
| Course 2 - $650 | Precision Control of Crystallization Processes - Friday, March 5, 2004 |
| Course 3 - $650 | Particle Characterization - Friday, March 5, 2004 |
| Course 4 - $650 | Synthesis, Processing and Properties of Metal Oxide Nanopowders - Saturday, March 6, 2004 |
| Course 5 - $650 | Size-Reduction Dispersion Technology - Saturday, March 6, 2004 |
| Course 6 - $650 | Cancelled |
| Select Any Applicable Discounts
[and subtract discount(s) from base course fee(s)]:
Registered for
Particles 2004 Conference - $50 discount per course
|
| Method of Payment:
(All payments must be in U.S. dollars) |
Cancellations & Refunds |
| Check Enclosed Checks must be drawn upon a U.S. bank. Make checks payable to: Particles Conference (EIN 16-1565388) | Registration fees are refundable, less a 15% service charge, if cancellation is made earlier than 14 days before the couese date. No refunds will be given after that date. All cancellations must be confirmed in writing. Substitutions from the same organization may be made at any time without penalty. |
| Payment by wire transfer | Wire payments to Manufacturers and Traders Trust Company (44 Exchange
Boulevard, Rochester, NY 14612, USA), ABA Routing No. xxxx, Particles
Conference Account No. xxxx; transfer fees not included in wire payment
are due upon registration on site (contact conference office for Routing and Account Nos.).
Do not use this option after 20 February 2004. |
| Visa Master Card American Express |
| Card No. | Exp. Date | |||
| Name on Card | Signature |
______________________________________ |
| Or mail to: Particles
Conference
265 Clover Street Rochester, NY 14610-2246, U.S.A. |
Call (585) 288-5913 E-mail: info@nanoparticles.org |
Please fill out (type before printing), print, sign this form, and submit via fax or mail.
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