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.