nanoparticles.org - Particles Conference Registration Form


	Particles 2004 Conference Registration Please fill out (type before printing), print, sign this form, and submit via fax or mail (see bottom of this page).


Mr. Ms. Dr. Prof. (Check all that apply.)


Name				Telephone
Title				Fax


Organization


Address		E-Mail
Address


City/Town		State/Province


Zip/PostalCode			Country

Fee or Fees in US$ Due (Type in amount in dollars):


Meeting Registration Accompanying Person		Speakers, Poster Presenters, Exhibitors: US$475 Students (Full time graduate or undergraduate): US$400 Regular Attendees: US$675 Accompanying Person: US$200

Accompanying person's name:
Check if you would like us to make on-site reservations for you at the Rosen Centre Hotel and guarantee your reservation with your credit card. The required deposit or guarantee is 112.5% ($178.88) of one night's room rate. Changes and cancellations should be made by directly contacting the Rosen Centre Hotel at
1-800-204-7234 or 1-407-996-9840.

Arrival Date Number of nights
If you are sharing a room, please enter other person's name:


*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)*	Meeting registration fees are refundable, less a 15% service charge, if cancellation is made earlier than 6 Fenruary 2004. No refunds will be given after that date. All cancellations must be confirmed in writing. Substitutions from the same organization may be made without penalty. Hotel deposits or guarantees are fully refundable if cancelled five days prior to arrival date.


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.).


*Visa Master Card American Express*


Card No.			Exp. Date
Name on Card			Signature	______________________________________

Please fax completed registration form to: (585) 482-7795 (No cover sheet required)


Or mail to: Particles 2004 *265 Clover Street* *Rochester, NY 14610-2246, U.S.A.*	*Questions?* *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.

For Short Course/Workshop Registration Click HERE