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REGISTRATION FORM FOR THE TWENTIETH ASP MEETING
SAN DEIGO, CALIFORNIA
JUNE 27 - JULY 1, 1997
Name (as it will appear on name tag) ___________________________________________________
Short name, also to appear on name tag (e.g. "Sue"; "Bill") ____________________________
What affiliation would you like on your name tag? ______________________________________
Telephone( )_______________ FAX( )_______________ E-mail _________________________
Registration Fee Schedule (fees are not refundable)
Membership status (check one): before JAN. 15 / after JAN. 15
____ Regular member $110.00 / $150.00
____ Student member $70.00 / $100.00
signature of faculty advisor _______________________________
____ Non-member $150.00 / $190.00
____ Guest (attends social events only) $75.00 / $115.00
name of registered participant sponsoring you as a guest _____________________
ASP T-shirts are $15. Indicate number of: ___small ___med. ___large ___x-large = $______
AMOUNT ENCLOSED: REG.FEE $___________ + T-SHIRT(S) $___________ = $_____________
(MAKE CHECK PAYABLE TO ASP)
Are you submitting an abstract as presenting/senior author? ___no ___yes
If yes: Send this form with abstract, disk, and other forms, along with a check
for the registration fee, to Dr. Evan Zucker, Department of Psychology,
Loyola University, New Orleans, LA 70118. POSTMARK DEADLINE: JANUARY 15, 1997.
If No: Send this form and your registration fee to Dr. Nancy Caine, Department
of Psychology, California State University San Marcos, San Marcos, CA 92096.
SPECIAL NOTE: Registration includes the banquet/dance. What is your favorite dance song?
title ____________________________________________ by _______________________________