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
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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.