Registrn Form

QABP98
CONFERENCE REGISTRATION FORM
Please note that payment must accompany this form.

ATTENDEE INFORMATION

Family

Name _________________________________________

Title [Prof. / Dr. / Mr. / Mrs. / Ms.] _________________

First

Name ____________________________

Middle

Initial _________

Date of Birth [Month] _______ [Day] _______ [Year]_______

Affiliation / Institution _________________________________________________________________________________

Mailing Address _______________________________________________________________________________________

____________________________________________________________________________________________________

Postal-ZipState &

City ___________________________________Code_________________Country_________________________

Telephone Fax

Number ___________________________Number ______________________E-mail __________________________

COMPANION INFORMATION[Acompanying person(s) not participating in the scientific programme]

FamilyFirstMiddle

Name _________________________________________Name ____________________________Initial _________

Family

Name _________________________________________

First

Name ____________________________

Middle

Initial _________

TITLE OF
YOUR TALK(S):_________________________________________________________________________________

_________________________________________________________________________________

TOPICS:		Please check your primary and secondary level of interests (one each).
Primary Interest	Secondary Interest
o	o	TOPIC 1.
o	o	TOPIC 2.
o	o	TOPIC 3.
o	o	TOPIC 4.
o	o	TOPIC 5.
o	o	TOPIC 6.

WORKING GROUPS:		Please check your primary (where you intend to spend most of your working group time) and your secondary level of interests (one each).
Primary Interest	Secondary Interest
o	o	GROUP A.
o	o	GROUP B.
o	o	GROUP C.
o	o	GROUP D.

REGISTRATION FEE
Ë DEADLINE: NOVEMBER 15, 1997

ADDITIONAL CONFERENCE PROCEEDINGS

____ No. of Additional Bound Proceedings [one copy is included with registration fee]

CONFERENCE DINNER

Gala Banquet at the Monterey Aquarium

o $350.00*

$40.00 each

$50.00*

I will be accompanied

oYes

oNo

Accompanying Person(s) at $50.00 each

No. of
EXTRA

Tickets ___________

Total
EXTRA

Amount_____________

EXCURSION & LUNCH

Lunch at the historic forge in Carmel-by-the-Sea, Monterey Coast-line tour

I will be accompaniedoYesoNo

$30.00

Accompanying Person(s) at $30.00 each

No. of
EXTRA

Tickets ___________

Total
EXTRA

Amount_____________

GROUND TRANSPORTATION

Round Trip conference shuttle bus from/to San Francisco

and San Jose Airports: Indicate which Shuttle Bus Runs

you intend to use:
Ë Sunday, January 4 o A o B (CHOOSE ONE)
Ë Friday, January 9 o A o B (CHOOSE ONE)

$50.00*

TOTAL CHECK AMOUNT ENCLOSED_____________

METHOD OF PAYMENT:check in US Dollars drawn on an account with a corresponding US bank
and made payable to Stanford University. Payment at the conference site will be considered as LATE
payment and must be made in cash in US Dollars or American Express Travelers' Checks.

Please send your Registration Form and check (US Dollars drawn on accounts with a corresponding US bank) to:

QABP98 Conference Administrator
Stanford Linear Accelerator Center
P.O. Box 4339, MS 33
Stanford, CA 94305 USA

Express Mail Address:

2575 Sand Hill Road, MS 33
Menlo Park, CA 94025 USA

*REFUNDS: Unfortunately we will not be able to make any refunds on these items because of our
contractual arrangements with the conference vendors.