Go to Nanoparticles.org Home Page Particles 2013 Short Course 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

Select Course or Courses (click to activate checkbox; all fees in US dollars):
 
Course 1 - $725 Surface Modification Chemistries for Particles and Interfaces - Friday, 2 August 2013
Course 2 - $725 Particle Characterization - Saturday, 3 August 2013
 
Select Any Applicable Discounts [and subtract discount(s) from base course fee(s)]:

  Registered for Particles 2013 Conference - $50 discount per course
  Taking multiple courses: - $50 discount per course
  Group of two or more from same organization taking same courses - $50 discount per course (describe group:  )


Enter Total Course Fee (base fee minus discounts; in US dollars):

Method of Payment (All payments must be in U.S. dollars): Registration Transferability, Cancellations & Refunds
Check Enclosed 
Checks must be drawn upon a U.S. bank.  Make checks payable to:
Particles Conference
 (EIN 16-1565388)
Registrations are transferable and substitutions from the same organization may be made without penalty prior to and through arrival at the short course.
Short course registration fees are refundable, less a 20% service charge, if cancellation is made earlier than 15 July 2013. After this date refunds, less a 20% service charge, will be made only if the space is replaced by another short course student. Cancellations must be made or requested in writing by fax, and after 15 July 2013 such requests will be honored in order of receipt, if the space can be filled with another short course student.
Visa  MasterCard  American Express  Discover  Diners Club  Japanese Credit Bureau

Card No. Exp. Date
Name on Card Signature
______________________________________

Please fax completed registration form to:   1-585-482-7795   (No cover sheet required)


 Or mail to: Particles 2013
265 Clover Street
Rochester, NY  14610-2246, USA
Questions?
Call 1-585-288-5913
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

© 2013 Particles Conference