SOS10 Registration Form – March 6-9, 2006 – Maui, Hawaii, USA
Please answer all questions.
Contact Information
Name__________________________________________________________
Name on Badge________________________________
Affiliation_____________________________________
Mailing Address____________________________________________________________________
City_____________________________State/Province_______________Zip/Postal Code_________
Country_________________________
Email Address___________________
Telephone_______________________ Fax____________________
Security Information [This determines if you need Foreign National Request processing.]
US Citizen Yes No
If No, Country of birth______________________Country of citizenship_______________________
Registration Fees & Payment (No Refunds)
Early Registration, up to November 15, 2005 US$300
Regular Registration, up to January 2, 2006 US$400
LATE Registration, up to February 2, 2006 US$500
Additional dinner guest on March 9, 2006
Adult @ $35; children under 12 yrs @$15 ________
Total US$________
Method of payment
Payment (check one): Credit Card Check/Money Order
If you will be paying by Credit Card please click here.
Make checks/money orders payable to: SNL
Send this form (and check if you are paying by check) to:
Sandia National Laboratories
Attn: SOS10, MS1110
P.O. Box 5800
Albuquerque, NM 87185-1110 or fax to (505) 284-4520
U.S.A.
Shirt size S M L XL XXL
Special Needs _______________________________________________________________________