Print this page and snail-mail it with your check (sorry no credit cards).
5IMR Registration Form
Early Registeration Deadline: September 20, 1996
Name____________________________________Current Position_______________
Company Name_______________________________________________________
Mailing Address________________________________________________________
City______________________________State_________________Zip___________
Telephone_________________________Fax________________________________
E-Mail Address_____________________
US Citizen: Yes____ No____ (*If no, please fill out the following information)
Full Name:__________________________________________
Date of Birth________________________________________
Place of Birth________________________________________
Current Citizenship___________________________________
Employer___________________________________________
* Because this is a Sandia Laboratory sponsored event, DOE requires the
above information from non-United States citizens. Please fill in the above
information. No other action is required.
Will you be attending dinner Thursday, October 10th
on the Gateway Clipper Liberty Belle?
YES_______ NO_______ HOW MANY WILL ATTEND______
~ Please include a check to cover dinner expenses for your guest (s) @ $30/person
Make Check Payable To: Sandia National Laboratories
~ Dinner is complimentary for all conference attendees
~ Vegetarian Meals Available (Please indicate under Special Needs)
Will you be attending the Ansys, Inc. Tour on Friday, October 11th?
YES_______ NO_______ Will you need Transportation?______
Are you willing and able to give a ride to others?______
Early Registration @ $210 Per Attendee _____________
.... or after Sept 20 @ $250 Per Attendee _____________
Student Registration Fee @ $25 per person ___________
(include a photocopy of your Student ID)
Guest(S) Attending Dinner @ $30 Per Person _________
TOTAL AMOUNT ENCLOSED _____________________
Make CHECK or MONEY ORDER payable to:
Sandia National Laboratories
(Sorry, we may not accept credit cards)
MAIL TO:
SANDIA NATIONAL LABORATORIES
Attn.: Tammy Wilson, Conference Coordinator
PO Box 5800, MS0833
Albuquerque, NM 87185-0833
Special Needs
Please indicate here if you require special accessibility or accommodations
at this meeting. My requirements are: (e.g. vegetarian, disability accommodations,
audio/visual requirements for speakers, etc.)
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
You must make separate hotel reservations by September 19.
Mailing this form does not reserve a hotel room for you.
Additional Contact
Tammy Wilson, Conference Coordinator
Office: 505-844-0180
Fax: 505-844-8251
E-Mail: tjwilso@sandia.gov
Roundtable Home Page
(http://endo.sandia.gov/~samitch/roundtable96/)