ADVANCE REGISTRATION FORM American Chemical Society • 255th National Meeting & Exposition March 18–22, 2018 • New Orleans, LA 4 WAYS TO REGISTER PHONE - by March 22, 2018 508-743-0192 or 800-251-8629 Monday - Friday, 9 AM to 5 PM EST (credit cards only)
ONLINE - by March 22, 2018 www.acs.org/NOLARegister (credit cards only)
FAX - by March 22, 2018 Send completed form with payment to: 508-743-9604 (credit cards only)
MAIL - by February 5, 2018 Send completed form with payment to: ACS Registration c/o CDS 107 Waterhouse Road, Bourne, MA 02532
REGISTRANT INFORMATION Dr.
Prof.
Mr.
Ms.
First Name
(Required for member discount)
ACS Membership #
Mrs. Last Name
Job Title
Company/Institution/Agency Street Address City
State/Province
ZIP/Postal Code
Email Address
Country
Business Phone
Cell Phone
Ext.
Emergency Contact Name
Emergency Contact Number
I require special services or auxiliary aids in order to participate in the meeting
Describe
I would like to receive meeting alerts and special offers by text message. Regular messaging rates may apply.
I am an ACS Publications Author
I would NOT like to receive promotional emails from exhibitors and sponsors.
I am an ACS Publications Reviewer
DEMOGRAPHICS
REGISTRATION CATEGORIES & FEES
1. Professional Affiliation (check one)
ACS Members
(A) Academia (D) Student
(B) Government
(C) Industry
(E) Other
2. Highest Degree Received (check one) (A) A.S./A.A.S. (D) Ph.D.
(B) B.S./B.A. (E) Postdoc
(C) M.S. (F) Degree in progress
(G) Other
ACS Member or Society Affiliate Emeritus or Retired 50-year Unemployed (dues waiver req’d) Graduate Student Undergraduate Student Pre-College Teacher One-day Registrant
3. Professional Concentration (check all that apply) (a) Aerospace/ Transportation (b) Agriculture & Food (c) Analytical (d) Biochemistry (e) Biotechnology (f) Chemical Education (g) Chemical Information (h) Clinical/Diagnostic (i) Colloids & Surfaces (j) Combinatorial Chemistry (k) Computing/Molecular Modeling (l) Electronics/ Semiconductors (m) Energy/Fuels (n) Environmental (o) Forensics (p) Geochemistry (q) Glass/Ceramics/ Composites (r) Health & Safety
(s) Inorganic (t) Law/Legal Affairs (u) Lubricants/Oils (v) Marketing/Sales/ Business (w) Materials (x) Metals/Metal Products (y) Nuclear (z) Organic (aa) Paint/Coatings (bb) Personal Care/ Cosmetics (cc) P harmaceutical/ Medicinal (dd) Physical (ee) Polymers/Plastics (ff) Pulp/Paper/Wood (gg) Rubber (hh) Soap/Detergent/ Cleaners (ii) Textiles/Fiber (jj) Toxicology
M
Tu
W
Su
M
Tu
W
4. Is this your first ACS National Meeting? No
Standard
from Dec 11
after Feb 5
$475 $240 No Fee No Fee $240 $120 $120 $240
$570 $290 No Fee No Fee $240 $120 $120 $290
$830 $475 $240 $120 $475
$995 $475 $240 $120 $570
$50
$50
Th
Non-Members Chemical Scientist Graduate Student Undergraduate Student Pre-College Teacher One-day Registrant Th
Guest Registrant (1)
(1) Guest Registration - A Spouse or family member of the registering attendee having no affiliation with the field of chemical science and is not eligible to become a member of the ACS. Only one guest registration allowed per full or one-day registration.
Guest Name
5. Registration Subtotal
$60 $30
$60 $30
$
Standard
@ $65 ea.
@ $90 ea.
ACS will not be responsible for abstracts not picked up during the meeting.
7. Abstract Fees Subtotal $
GRAND TOTAL Registrant Procedures: U.S. attendees who register by February 5, 2018 will receive their registration credentials and tickets via mail prior to the meeting. Unless an international attendee has provided a U.S. mailing address on their registration form, their credentials must be picked-up onsite at the Attendee Registration (this includes Canada and Mexico). After February 5, 2018, registrations will continue to be accepted at the standard rate on-line and by phone or fax (credit card payment only) until March 22, 2018. Registration Cancellation/Refund Policy: By adhering to the following cancellation procedure, cancellations received by February 27, 2018 will receive a refund, less a $50 administrative fee. Registrants must return a copy of the registration confirmation along with the original registration credentials before refund will be issued. All refunds are issued via the same method used for payment. No cancellation/refund requests will be honored after February 27, 2018.
8. Grand Total of Sections 5-7 $
Check payable to American Chemical Society (in USD) VISA
MasterCard
Card #
PROGRAM BOOK FEE Program books will be available for purchase online from (Dec. 11 Feb. 5, 2018). Books will be available onsite while supplies lasts. Qty
ACS Member Flash Drive (pick up)
PAYMENT
Exposition Hall Only Adult Student
@ $20 ea.
6. Program Book Subtotal
(kk) Other
Yes
Su
Early
USB/ABSTRACT FEES
American Express
Diners
Exp Date
Billing Address & Zip
Card Holder Name $
SOCIAL EVENTS If you would like to review available Social Event tickets, please visit www.acs.org/NOLASocialEvents. You may purchase tickets by contacting the Customer Service office at 508-743-0192 or 800-251-8629. If you are paying by credit card, you can update your registration online by using your confirmation number.
Card Holder Signature By signing, the credit card holder agrees to pay the charges listed above in order to participate in the 255th ACS National Meeting in New Orleans, LA. By submitting this registration form, you agree to accept all terms and conditions to participate in the ACS National Meeting & Exposition.
The use of any device to capture images (e.g., cameras and camera phones) or sound (e.g., tape and digital recordings) or to stream, upload, or rebroadcast speakers or presentations is strictly prohibited at all official ACS meetings and events without express written consent from the ACS.
