NuFACT’00 Workshop

May 22-26, 2000
Naval Postgraduate School
Monterey, California

ADVANCE REGISTRATION
DEADLINE FOR ADVANCE REGISTRATION AND OPTIONAL FEES:  May 12, 2000

First Name	Middle Initial	Family Name	Organization or Affiliation
			
Organization Address		Organization Telephone
									
City	State	Postal Code	Country	FAX Number
		
Email Address
[    ]	I will stay at the  				   Hotel.  
	I will arrive 		/	 and depart 		/	 .
                                                                  month      day                                          month  day

[    ]	I have the following special needs________________________________________
REGISTRATION FEE (covers meeting materials, all sessions, coffee breaks and other conference costs)

Registration fees received on or before April 21, 2000
$225.00	$  __________

Registration fees received after April 21, 2000
$275.00											$  ___________

OPTIONAL FEES (DOE-funded attendees must pay with personal funds)

$75.00  Meal ticket 										$____________
(lunch Monday – Thursday at Naval Postgraduate School and reception Sunday night at Hilton Hotel)		
	Special Dietary Needs _____________________________________________________

$30.00  Banquet at Naval Postgraduate School						$____________

Total									 $ 		

We are unable to accept International Postal Money Orders, or Eurochecks.  Please enclose check in U.S. dollars drawn on an U.S. bank or International Money Order payable to:  REGENTS, UNIVERSITY OF CALIFORNIA

We accept payment by mail or fax using Visa, Mastercard, Diners Club, JCB or Carte Blanche.  Please complete the following information:

									
Type of credit card	Credit card Number			Expiration date

										
Print name as shown on credit card		Signature

Registration cancelled after May 15, 2000 may not be refunded.

Return this form with your payment to: 

Conference Coordinator
Lawrence Berkeley Laboratory Mailstop 937/500
Berkeley, California  94720  USA
FAX:  (510) 486-7772