NOAO > Meetings > Fred Gillett Symposium > Registration Form

Registration Form (Fred Gillett Symposium: Apr. 11 to Apr. 14, 2002)

Registration Forms are due by Mar 27, 2002

Note: Required fields are designated with an *.

Registration Information
First Name: *	Last Name: *	Name on badge:
Institution/Company: *
Address: *
City: *	State/Province: *	Zip/Postal Code: *
Country: *
Phone number: *	Fax:	E-mail: *
Spouse/Guest Name (if attending):

Credit card required to secure rooms, Rate/night, for early arrival and delayed departures.
Hotel Information
Hotel Arrival Date (YYYY-MM-DD):	Departure Date (YYYY-MM-DD):
Extended Stay Early Arrival Date (YYYY-MM-DD):	Delayed Departure Date (YYYY-MM-DD):
Hotel:
Smoking Preference:	Bed Preference:
Room Share	Will share a room with:
Please find a roommate	I am:
Special Needs:

Travel Information
I will arrive at:
Arrival Date (YYYY-MM-DD):	Arrival No (e.g. Airline/Flight):	Time:
Departing Date (YYYY-MM-DD):	Departure No (e.g. Airline/Flight):	Time:

Transportation Information
	I am happy to rent a vehicle if asked to:

Questions? Contact Kathy English at (520) 318-8135 or by e-mail: kenglish@noao.edu

NOAO > Meetings > Fred Gillett Symposium > Registration Form

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