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| REGISTRATION FORM FOR THE TWENTY-FIFTH ASP MEETING |
| OKLAHOMA CITY, OKLAHOMA -- JUNE 1-4, 2002 |
| NAME (as it will appear on name tag) |
_________________________________________________________ |
| ADDRESS: |
_________________________________________________________
_________________________________________________________
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| AFFILIATION (for name tag): |
_________________________________________________________ |
| TELEPHONE: _______________ |
FAX: _______________ |
EMAIL: ___________________________ |
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| REGISTRATION FEES (fees are NOT refundable) |
| SPECIAL NOTE: REGISTRATION INCLUDES CONTINENTAL BREKFASTS,
LIGHT SNACKS, RECEPTIONS, THE BANQUET, & LUNCH). Please not on-site
registration LATE fee; register early! |
| MEMBERSHIP STATUS |
BEFORE JAN 18 |
AFTER JAN 18 |
[ON SITE] |
| Regular member |
$160.00 q |
$210.00 q |
[$260] |
| Student member* |
$105.00 q |
$125.00 q |
[$145] |
* Must be a current student member of ASP
Faculty Advisor's Signature _________________________________________________________
|
| Non-Member |
$210 q |
$255 q |
[$300] |
|
Guest (attends social events only)**
|
$95.00 q |
$115.00 q |
[$135] |
| (see back of page for guest registration) |
| REGISTRATION PAYMENT OPTIONS: CHOOSE ONE |
| CHECK OR MONEY ORDER (make checks payable to ASP) q CREDIT CARD q |
q Visa
q Mastercard
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Card Number ______________________________________
Exp Date ___________ |
| Authorizing Signature: |
_________________________________________________________ |
| Volutary contribution to cover credit card processing fees (3.5%) |
$__________ |
| Total charge to credit card |
$__________ |
| PAYMENT ENCLOSED: |
Reg. Fee |
+ Guest = |
$__________ |
| Did you order a T-Shirt? q (complete t-shirt form) |
| ARE YOU SUBMITTING AN ABSTACT AS PRESENTING AUTHOR? q YES q NO |
| ABSTRACT TITLE: |
_________________________________________________________ |