Advance registration —210th ACS National Meeting Chicago, III.
Aug. 2 0 - 2 4 , 1995
PLEASE ALLOW SUFFICIENT TIME FOR YOUR MAIL TO REACH US. Deadline Deadline Deadline REFUND
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for receipt of registration: July 21 for requests for full refunds: Aug. 11 for requests for partial refunds: Sept. 8 REQUESTS RECEIVED AFTER SEPT. 8 WILL NOT BE HONORED
Make check (U.S. dollars) payable to: ACS or American Chemical Society
PLEASE SUBMIT A SEPARATE FORM FOR EACH REGISTRANT D Dr.
D Mr.
D Miss
D Ms.
D Mrs.
Surname
Forward this form with payment to: American Chemical Society, Meetings P.O. Box 18598 20th St. Station Washington, D.C. 20036-8598 or Fax with credit card payment to: (202)833-7711 or (202) 872-6128 or 872-4081 M.I.
First or Nickname
| Name for badge | Affiliation | Street address I City, State
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I Country | Telephone (office, home) I Days at meeting:
1
DSu
2
DM
3
DT
4
DW
5
DTh
FAX
Type of affiliation:
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D Academia
ZIP
D Government
D Industry
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Check one of the following employment fields: D Agrochemicals/Food D Analytical Chemistry D Biochemistry/Biotechnology D Catalysis D Chemical Education D Colloid Chemistry/ Surfactants D Environmental Chemistry D Inorganic Chemistry/Materials D Nuclear/Radiochemistry D Organic Chemistry D Personal Care/Household Products D Petroleum Products D Pharmaceuticals D Physical Chemistry Π Polymers/Plastics/Organic Materials D Please check here if you are disabled and require special services. We will contact you prior to the meeting. Please list ALL of the division(s) to which you belona: I D PLEASE CHECK HERE IF YOU DO NOT WISH TO 1DECEIVE E X H I B I T O R P R O D U C T O F F E FEINC;s. FEES: Registration—check one only 1 D Member @ $190 2 D National affiliate @ $190 3 D Nonmember: U.S. resident chemical scientist @ $285 4 Π Member emeritus/retired @ $85
1 FEES>: Event tickets Event No. No. tickets
F EES : Abstracts
(3) $
_
One-day: D S u D M D T D V v1 DTh 13 14 15 16 17 18
D Adult @ $100 D Undergraduate student (member) $5.00 D Graduate student (member) @> $5.00 D Undergraduate student (nonmeniber) @ $5.00 D Graduate student (nonmember) @.$5.00 D Precollege teacher @ $5.00
(1) Fee total $
$ $
$ $
7 D 50-year member (No fee) 8 D Unemployed member (No fee)
12 D Graduate student (nonmember)
Total
$ $
Visitor 5 D Non-U.S. resident or nonchemical scientist or chemical technician @ $190 6 D Guest of registrant @ $15 Note: Separate form must be completed
Student: less than postdoctoral status, @ $15 9 D Undergraduate student (member) 10 D Graduate student (member) 11 D Undergraduate student (nonmember)
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. Sets at $45—nonmember . Sets at $35—member . Sets at $30—division member aivision
D Will pick up at meeting. D Postage is $6.00 for the mailing of each set of books. (U.S. ONLY) (3) Abstract total,$ (4) Abstract postage !?
(2) Ticket total $ Social Security No. Date of Birth _ (Information r equired for Tour GP-5 only)
TOTAL REMITTED !i (1,2,3,4)
DEADLIISIE FOR RECEIPT: JULY
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Registrations paid by credit card ONLY may be faxed to any of the numbers listed above. However, do not mail £ind fax; otherwise duplicate charges will occur.
Paid by:
D Check Π American Express D Vr isa Π MasterCard
D Diners Club
Expiration date
Credit card account No. Cardholder:
Signature
Mailing address for registration materials and abstracts. [Note: Registratio η materials c a n b e mailed to all registrants. Abstracts c a n b e mailed via UPS to U.S. residents; complete address (no P.O. Box numbers ) must b e given]. D Same as above D Street City, State, ZIP 84 JUNE 19,1995 C&EN
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