Online Registration Form

Please register by September 29th, 2006

Name:
Organization:
Address:
City:
State/Province:
ZIP Code:
Phone:
FAX:
E-mail: 

I have the following special needs:

Do you require vegetarian meals:    Yes     No

The registration fee includes breakfast, lunch, breaks on Friday and Saturday and the banquet Friday evening. You are welcome to pay for an additional guest at the banquet if you would like.

$80 Registration Fee (includes the banquet)
I plan on attending the banquet yes no

$0 Student Registration Fee (no charge, does not include the banquet)
I plan on attending the banquet (if yes, $20 banquet fee applies) yes no

Student/Guest Banquet: $20 Name:

 

If you plan on presenting a poster:

How many? Format: Landscape Portrait

If you want the poster printed by SRC, please send to Chris Moore (cmoore@src.wisc.edu) by October 15th (PDF or Powerpoint).

Payment Methods

You may pay on-site by cash or check only. Make checks payable to "University of Wisconsin-Madison". To pay with a credit card, please fax (608-877-2001) or send in the paper version of the registration form.

Note: For UW employees, you may submit an internal requisition issued to the Synchrotron Radiation Center through your UW department, but it must state "confirming requisition" in the explanation and include the fund 136 A 34 9200 4 3350.