CONFERENCE REGISTRATION FORM
1997 Particle Accelerator Conference
12-16 May 1997

Please type or print:

______________________________________________________________________________
family name       		first name			middle initial

______________________________________________________________________________
institution/company (for name tag)

______________________________________________________________________________
mailing address for proceedings

______________________________________________________________________________
city               state/province          postcode          country

___________________________________     ________________________
e-mail address                          fax number

___________________________________
hotel booked

___________________________________
name of companion


Proceedings Option:     CD-ROM ______	Book ______



FEES			 Number	  Payment received  Payment received	Amount
		        required     by April 21     after April 21    Remitted
--------------------------------------------------------------------------------
                                     Cdn$    US$      Cdn$    US$    Cdn$   US$

Registration fee
(includes Proceedings)    ____        390    280       460    330    ____  ____

Student/retiree fee
(no Proceedings)          ____         70     50        70     50    ____  ____

Barbecue (May 12)         ____         22     16   	32     23    ____  ____

Banquet (May 14)          ____         50     36        60     43    ____  ____

Dietary Restrictions ___________________________   

City Tour (May 12)           ____      27     20        33     24    ____  ____

North Shore Tour (May 13)    ____      45     33        54     39    ____  ____

Victoria Excursion (May 15)  ____      79     57        91     66    ____  ____

UBC Museum Tour (May 16)     ____      27     20        30     22    ____  ____

Whistler Excursion (May 17)  ____      41     30        45     32    ____  ____


Extra copies of Proceedings:

                Books     ____        160    115       160    115    ____  ____

                CD-ROMs   ____         40     29        40     29    ____  ____


TOTAL REMITTED,	payable to "TRIUMF (PAC'97)":

  by bank draft or money order in Canadian or US funds:		     ____  ____

  by cheque, in Canadian funds drawn on a Canadian bank              ____

  by check, in US funds drawn on a US bank                                 ____

  by credit card (must be authorized in Canadian funds)              ____

  Visa  _____   MasterCard _____   Amex _____   Diners Club _____

  __________________________________         _______________________________
  Card holder (exact name on card)           Card number

  __________________________________         ___________
  Signature				     Expiry date



  RETURN THIS FORM BY MAIL TO:  PAC'97 Registration
		               	TRIUMF
                		4004 Wesbrook Mall
		        	Vancouver, B.C.
                 		Canada V6T 2A3

                 OR BY FAX TO:  604-222-7309
PARTIAL REFUNDS will be granted if a written request is received
before the conference - see details under CONFERENCE REGISTRATION.