Deadline -- JUNE 1, 2000
Please fill out a form for each person registering. This form may be duplicated. Your name badge will contain your name, city, state, and major field as printed below on the left:
Name:____________________________________ Mailing Address:_______________________________
Major field:________________________________ E-mail:_______________________________________
Registration Fees (per person): No refunds after July 1, 2000.
ASA Member $150 $___________
Non-Member $175 $___________
Full-time Student $ 75 $___________
Spouse/Family Member $ 75 $___________
Late fee for registrations
postmarked after June 1 $ 30 $___________ Registration Total $___________
Lodging at Gordon College: Thurs. Fri. Sat. Sun.
Apartments: bedroom, shared bath, and sitting area.
Single occupancy will be $45 per night: $45 X _________ =
Single sleeping - shared bath No. of nights
Double occupancy will be $35 per person per night: $35 X ________ = Double sleeping - shared bath No. of nights
Dormitory style lodging (two - three per room)
$29 per person per night: $29 X ________ = Lodging Total $___________
No. of nights
Meal Package at Gordon College: Friday dinner through Monday lunch: $105
Including a New England Clam Bake on Saturday night.
Please specify ______ Lobster or ______Chicken Meal Total $___________
Whale Watching Trip:
Cost: $25 for adults, $22 for children under 16 years Whale Watching $___________
(Includes admission and transportation)
Pay on board for lunch ($6.00)
TOTAL AMOUNT ENCLOSED $___________
Mail this form with your check made payable in US funds to:
American Scientific Affiliation, PO Box 668, Ipswich, MA 01938
or you may pay via credit card by filling in the information below.
MasterCard or Visa ---
Signature:_______________________________ Expiration date: ____________
Name as it appears on your credit card:________________________________