Particle Society 2008 Spring Symposium Registration Form

1. Complete your Contact Information (Please print)

First and Last name

What is your primary job title?

Company Name

Company Address

City   State   Zip

E-mail address   phone number

2. Lunch food choices

Crispy Chicken Parmesan

Grilled Sirloin

I prefer a Vegetarian meal

3. Payment options

General admission:         $175.00

Morning only general admission:          $125.00

Afternoon only general admission:        $125.00

Student admission:               $  40.00

4. Provide payment information (select one)

PAY BY CREDIT CARD using the Paypal option at the bottom of the previous page (submit this form first)

I will be mailing a CHECK payable to “Particle Society of MN” (a receipt will be mailed to you).

IF PAYING BY CHECK PLEASE MAIL THIS REGISTRATION FORM ALONG WITH YOUR PAYMENT TO THE FOLLOWING:

ATTN: Debbie Paetznick – PSM Registration

University of Minnesota – FScN bldg.

1334 Eckles Avenue

St. Paul , MN 55108

5. OPT OUT: The goal of the Particle Society is to facilitate interdisciplinary relationships throughout the industry and create a forum to develop those relationships.  As a service to our membership we will be distributing an attendee list with everyone’s name and contact information registered for the Program.  If it is your preference that we not disclose your information please initial here .