SOS10 Registration Form March 6-9, 2006 Maui, Hawaii, USA

Please answer all questions.

 

Contact Information
Name__________________________________________________________

Name on Badge________________________________

Affiliation_____________________________________

Mailing Address____________________________________________________________________

City_____________________________State/Province_______________Zip/Postal Code_________

Country_________________________

Email Address___________________

Telephone_______________________ Fax____________________

 


Security Information [This determines if you need Foreign National Request processing.]

US Citizen Yes No

If No, Country of birth______________________Country of citizenship_______________________

 

 

Registration Fees & Payment (No Refunds)

Early Registration, up to November 15, 2005US$300

Regular Registration, up to January 2, 2006  US$400

LATE Registration, up to February 2, 2006 US$500

Additional dinner guest on March 9, 2006

Adult @ $35; children under 12 yrs @$15 ________

Total US$________



Method of payment

Payment (check one): Credit Card  Check/Money Order 


If you will be paying by Credit Card please click here.



Make checks/money orders payable to: SNL

Send this form (and check if you are paying by check) to:

Sandia National Laboratories

Attn: SOS10, MS1110

P.O. Box 5800

Albuquerque, NM 87185-1110 or fax to (505) 284-4520

U.S.A.

Shirt size S M  L  XL  XXL 

 

 

Special Needs _______________________________________________________________________

 

For questions contact: Deanna Ceballos at (505) 845-7753, drcebal@sandia.gov