Go to Nanoparticles.org Home Page Short Course Registration
Hilton Garden Inn - Philadelphia Center City, Philadelphia, PA 19107, USA
Monday, 24 July 2017, 8:30am - 4:30pm


Registration includes copy of all slides in electronic book (pdf) on USB stick,
luncheon, and morning and afternoon coffee breaks.
Please fill out (type before printing), print, sign this form,
and submit via e-mail (after scanning) or fax or mail (see bottom of this page).

Mr Ms Dr Prof.      (Please 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 - Surface Modification Chemistries for Particles and Interfaces- Monday, July 24, 2017
 
Identify net fee (check only one box):

   $1095 - NOT a full time student (undergraduate or graduate)

   $550 - Full time student (undergraduate or graduate)


Please Enter Net Course Fee (in US dollars) from Box Checked Above:

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 may be made without penalty prior to and through arrival at the short course. A written note signed by the original registrant or an e-mail note from the original registrant dated prior to 8am on 24 July 2017, authorizing transfer, must be provided to effect registration substitution.
Short course registration fees are refundable, less a 20% service charge, if cancellation is made earlier than 8am (Eastern time) of 24 July 2017 in writing by e-mail to Melanie Martin (martin@nanoparticles.org).
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Card No. Exp. Date
Name on Card Signature
______________________________________

print, sign, and scan this form, and send electronically to
Melanie via e-mail at martin@nanoparticles.org
Call Melanie at 585-413-8264 if you have questions or problems.
Please make sure you receive a registration acknowledgment and receipt.

Questions? Call 1-585-413-8264