CONFERENCE REGISTRATION FORM

Conference Registration Form The First International Conference on Environmental Science and Technology January 23-26, 2005, New Orleans, Louisiana, USA (This form can be downloaded from http://www.AASci.org/conference/env/registrationform.pdf) Last Name (Surname)_______________________________________________________________________________________ First Name (Given Name)______________________________________________________________M.I.___________________ Deparrment_______________________________________________________________________________________________ Institution_________________________________________________________________________________________________ Address (Street Number and Name)____________________________________________________________________________ City_______________________________________________State/Province___________________________________________ Postal/Zip Code ____________________________________ Country ________________________________________________ E-mail___________________________________________________________________________________________________ Phone_____________________________________________ Fax___________________________________________________ Industry (regular)-, government-, and university-rate registrants will receive the proceedings by mail after the conference; student and one-day attendance registrants will not receive the proceedings, but e-version proceedings (CD). By 31 October 04 After 31 October 04 Industry (Regular) US$725 US$825 University/Government US$675 US$775 Full-time Student US$375 US$425 US$275 US$295 One-day Attendance ( 1/23; 1/24; 1/25; 1/26) All presenters and session chairs are expected to register before the conference with standard fees. The early registration discount offer applies only if payment has been received by October 31, 2004. The government fee offer applies only to employees of government agencies and does not apply to government contractors. A copy of current student ID is required to receive the student fee. To confirm your registration, payment is required: Wire Transfer (Bank and Account: Bank One, 729 Harrison Ave., New Orleans, LA 70124, USA; Bank Routing number 065400137 (for USA domestic) or # BONE US 44 (swift code for international); Account number 646681197. Account Owner: American Academy of Sciences) Money Order; Check (Money Order or Check must be drawn on a U.S. bank and payable in U.S. funds to American Academy of Sciences and reference the Environmental Conference) American Express Visa MasterCard Credit Card Number______________________________________________ Expiration Date(mm/yy) ______ / ______ Card Holder______________________________________________________________________________________ Signature of Cardholder __________________________________________ Paid U.S.$ ________________________ The registration fee is available for refund only if the cancellation is received by December 31, 2004. No exceptions apply, but all paid registrants will still receive the materials covered by the registration fee regardless of attendance. Substitutions are accepted however; advance notice would be greatly appreciated. If AAS cancels the event due to circumstances beyond AAS’s reasonable control including but not limited to acts of God, government emergency, labor strikes, acts of war, and/or unavailability of the event facility, AAS will refund to attendee his/her paid registration fee minus a portion of the event costs acquired by AAS. This refund will be the attendees’ exclusive remedy and AAS’ only liability for cancellation of the event for reasons described above.

Registration Methods: Online Via Web: http://www.AASci.org/conference Fax: 504-486-6332 E-mail: [email protected] Mail: Environmental Conference American Academy of Sciences 6464 Avenue B New Orleans, LA 70124, USA

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FOR OFFICE USE ONLY DATE ___________ FEE $_________ REG # _________________________ REC #_________________________ OFFI #_________________________