Use your browser to PRINT this form, then use its BACK button to return to the previous page.
REGISTRATION FORM FOR THE TWENTY-FOURTH ASP MEETING
SAVANNAH, GEORGIA
AUGUST 8-11, 2001
Name (as it will appear on name tag) ___________________________________________________
Short name, also to appear on name tag (e.g. "Sue"; "Bill") ____________________________
Address ________________________________________________________________________________
________________________________________________________________________________________
Affiliation for name tag ______________________________________
Telephone( )_______________ FAX( )_______________ E-mail _________________________
Registration Fee Schedule (fees are not refundable)
SPECIAL NOTE: Registration includes Continental Breakfasts,
Light Snacks, Receptions, and the Banquet
Membership status (check one): before APR 1 / after APR 1
____ Regular member $150.00 / $200.00
____ Student member* $100.00 / $115.00
*must be a currently paid up student member of ASP
signature of faculty advisor _______________________________
____ Non-member $200.00 / $250.00
____ Guest (attends social events only)** $ 85.00 / $105.00
**Guests see guest registration form for more information
ASP T-SHIRT $15 EACH ____Small ____Medium ____Large ____X-Large ____XX-Large
REGISTRATION PAYMENT OPTIONS: CHOOSE ONE
- Check or money order (make checks payable to ASP)
- Credit card
AMOUNT ENCLOSED:
REG.FEE $_________ + guest(s) $_________ + T-Shirt(s) $_________ = $_____________
Credit Card Payers only:
Voluntary contribution to cover credit card processing fee (3.5%) $_____________
Total to put on card: $_____________
___Visa ___Mastercard Card number:________________________ Exp. date:________
Authorizing Signature: _______________________________________________________________
Are you submitting an abstract as presenting/senior author? ___no ___yes
(title____________________________________________________________________________)
ALL MATERIALS SHOULD BE MAILED TO:
Dr. Tammie Bettinger, ASP Program
Zoo Atlanta Reminder- Make your hotel reservations early
800 Cherokee Ave S.E.
CAtlanta, GA, 30315-1440 USA
POSTMARK DEADLINE: APRIL 1