International Conference on Undergraduate Physics (ICUPE) July 31-August 3, 1996
Registration and Accommodation Form
(Use one form per person. Print or photocopy extra forms as needed.)
Complete this form (use block letters) and mail to: Conference & Visitor Service, University of Maryland, 0101 Annapolis Hall, College Park, MD 20742 USA or fax (purchase order or credit card registrations only) to 301/314-6693
Name:____________________________________Organization:_____________________________
Address:__________________________________________________________________________
City ____________________State__________Postal Code____________Country_______________
Fees (Check all that apply)
- Registration
- _____ $290 (if postmarked on or before May 10, 1996)
- _____ $350 (if postmarked after May 10, 1996)
- Housing
- _____ $175 (lodging and meals package, nights of July 30-August 2)
- _____ $20 (supplement for a single room)
- _____ $30 (supplement for night of August 3)
- Meal Plan (Choose this ONLY if you do not choose Housing.)
- _____ $60 (limited meal plan option for those not residing in campus residence halls)
- Total enclosed
- ______________
Payment Method
- _____ Check enclosed (in US funds on a US bank)
- _____ International money order enclosed (in US funds)
- _____ Purchase order #____________________
- _____ Visa / MasterCard Card #_______________________________
- Expiration Date __________ Signature__________________________
Housing Special Requests
- _____ I would like a single room (the supplementary single fee above must also be checked)
- _____ Please assign me a non-smoking room.
- _____ I would like to room with the following conference participant ________________
Special Needs
If you have any special needs or requests, please explain:_______________________________________
Other Information
- _____ I plan to submit a contributed paper to the conference.
- _____ I plan to also attend the August 5-10 AAPT Meeting in College Park. (Note: You must register for that meeting through the AAPT. Marking this line will permit us to correlate you housing requests so you do not have to switch rooms between conferences.)