SOS10 Registration Form – March 6-9, 2006 – Maui, Hawaii, USA

Please answer all questions.

Contact Information

Name on Badge________________________________


Mailing Address____________________________________________________________________

City_____________________________State/Province_______________Zip/Postal Code_________


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


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Special Needs  _______________________________________________________________________