Advance registration—192nd ACS National Meeting - ACS Publications

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Advance registration—192nd ACS National Meeting Anaheim, Calif.

Sept. 7-12, 1986

Deadline for receipt of registration: Aug. 15 Deadline for requests for full refunds: Aug. 29 Deadline for requests for partial refunds: Sept. 30

Mail this form with p a y m e n t to: American Chemical Society, Meetings, P.O.Box 18598 20th Street Station Washington, D.C. 20036-9998

M a k e c h e c k p a y a b l e to: A C S or A m e r i c a n C h e m i c a l Society Please submit a s e p a r a t e form for e a c h registrant. D Dr.

D Mr.

D Ms

Π Miss

D Mrs.

Surname

M.I.

First or Nickname

Name for badge Affiliation Affiliation address City, State ZIP, Country Telephone (office, home)

Days at meeting: D

1

DSu

2

DMo

3

DTu

4

DWe

5

DTh

6

DFr

Type of affiliation:

D Academia

D Government

D Industry

Please check here if you need special services for the handicapped. We will contact you prior to the meeting.

Address during meeting Which division's program influenced you to attend: m o s t .

_ next.

FEES: Registration—check one only 1 2 3 4 5 6 7 8 9

D D D D D D D D D

Member (a, $90 National affiliate (& $90 Nonmember: U.S. resident chemical scientist @ $165 Member emeritus (a $35 Visitor: non-U.S. resident or nonchemical scientist or chemical technician (a $90 Visitor: family of registrant (a $15 Student: less than postdoctoral status, member or nonmember (a $15 One day (« $60 | - D Mo 3 D Tu 4 D We 5 D Th 6 D Fr One day student (a $5.00

FEES: Event tickets Event No. No. tickets

Registration fee $_ (r/

Total

Ticket total $_ FEES: Abstracts Sets at $34—nonmember Sets at $26—member .division Sets at $24—member o f _ D Will pick up at meeting Π Enclosed is $3.00 for each book mailed (U.S. only). Provide street address

Paid by:

Abstract total $_ Abstract postage $_ TOTAL REMITTED $_

D Check D American Express D VISA D MasterCard D Diners Club/Carte Blanche

Expir. date

Credit Card Account No. Cardholder:.

MasterCard Interbank Code (four numbers above your name)

Signature:. Mailing address for registration materials and abstracts. (Note: Registration materials can be mailed to U.S. and Canadian residents only. Abstracts can be mailed to U.S. residents only.) D Same as above D Send to: Street City, State, ZIP 62

June 23, 1986 C&EN

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