Registration Fee Form
Workshop on In Situ Methods in Nanomechanics
August 1-3, 2007, LBL, Berkeley, California, USA
$200/attendee for advance payment (June 29 deadline), or
$250/attendee for payment at the workshop
Attendee:
(Note: gray boxes are fill-in fields)
Name:
Affiliation:
Advance Payment Check Option:
Make the check (cheque) payable in US funds to “Workshop on In Situ Methods
in Nanomechanics” and mail it with the completed Registration Fee Form to the
following address:
Workshop on In Situ Methods in Nanomechanics
Post Office Box 44698
Eden Prairie, MN 55344 USA
Advance Payment Credit Card Option:
Email a scanned copy of the completed Registration Fee Form to
in.situ.workshop@gmail.com or mail it to the address provided under Advance
Payment Check Option.
(Check only one checkbox)
Visa
MasterCard
Discover
American Express
Card Number:
Expiration Date: Month
Year
Card Security Code (CVV2, CVC2, or CID):
(Three digits on the back of Visa, MasterCard, and Discover cards; four digits on
the front of American Express cards)
Name (as shown on card):
Signature: ________________________________________________________