SOS10 Registration Form – March 6-9,
2006 –
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, 2005 US$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
Shirt size S M
L XL XXL
Special Needs _______________________________________________________________________
For questions
contact: Deanna Ceballos at (505)
845-7753, drcebal@sandia.gov