Registration Form for POLYCHAR

For participation at POLYCHAR please print, fill out and sent the registration form as well as your abstract below to:

REGISTRATION FORM:

Title, First Name, Last Name:
________________________________________________________________
Institution:
________________________________________________________________

Postal address (separate lines on a label):
________________________________________________________________
________________________________________________________________

Telephone: _____________________ Fax: ______________________________

e-mail: _____________________ Home page:____________________________

Interested in: ___ Research sessions, ___ Short course, ___ both

I would like to present paper(s): __ orally, __ as posters
(check 0,1 or 2, give titles if not 0):
________________________________________________________________
________________________________________________________________

Members: __ ACS, __ APS, __ MRS, __ SR, __ SPE, __ IUPAC

Student: __ (y/n)

Regular or vegetarian lunch: __ (r/v)

Our internet registration is currently not available.

Maintained by Oscar Olea-Mejia
Last updated on October 26th, 2006