SETCA 2008

 

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Conference Registration Form

First Name* :                                                                                Last Name* :

                      

Name to appear on the badge :

Organization* :                                                                              Department :

                      

Street Address (Line 1)* :                                                           Street Address (Line 2) :

                     

City* :                                                                                             State* :                                Zip Code :

                                      

Country* :

Phone* :                                                                                         E-mail* :

                       

Personal Check

Please make your check payable to David A. Dixon for the amount of $55.00 and mail it to:
                                                                        

          April McIntosh

          Department of Chemistry

          The University of Alabama

          Shelby Hall, Box 870336

          Tuscaloosa AL 35487-0336

 

If you wish to bring a guest to the banquet, please include an additional fee of $25.00.

 

Please note that if you choose to register at the meeting, we can only accept cash and personal checks as payment.

Credit/Debit card payments will not be possible on site.