REGISTRATION FORM TO BE SUBMITTED BY APRIL 20, 2001. In order to REGISTER, please follow these instructions: - Fill in the form below and e-mail it to ceres2001@astropa.unipa.it. In the "subject" of your e-mail, please write: Your surname - Registration - If you prefer to fax your registration form, please mark it "Attention of Donata Randazzo" and transmit it to the fax number 0039 091 233 444 (from the USA dial 011 39 091 233 444). If you are paying by bank cheque or postal money order, please add a copy of your transaction receipt. In either case, you will be notified as soon as possible of the receipt of your registration request. LAST NAME ___________________________________________________________ FIRST NAME___________________________________________________________ AFFILIATION___________________________________________________________ POSTAL ADDRESS______________________________________________________ TELEPHONE NUMBER__________________________________________________ FAX____________________________________________________________________ E-MAIL ADDRESS_______________________________________________________ Please state your professional or student status and field ________________________________________________________________________ Ordinary Student rate Accompanying person rate Late registration (after April 20th, 2001) Lit. 750,000 Lit. 350,000 Lit. 300,000 Payment options I wish to register for the Asteroids 2001 meeting. Lit. __________________________ for myself and Lit. _________________for no._______ accompanying person(s). Name(s) of the accompanying person(s) _______________________________________________ Total Lit. _______________________________________ Please charge AMERICAN EXPRESS VISA MASTERCARD Number ______________________________________ Expiring _________________ I have already arranged for: Bank cheque Postal money order to be made to "Comitato Ceres 2001" and sent to the following address: Comitato Ceres 2001, c/o Osservatorio Astronomico di Palermo, Piazza del Parlamento 1, I-90134 Palermo, Italy. I am sending a copy of the bank/post office transaction to the attention of Donata Randazzo at the fax number 0039 091 233 444 (from the USA dial 011 39 091 233 444). PLEASE NOTE Cancellations: 90% refund if LOC is notified before June 3rd; 50% refund if LOC is notified after June 3rd.
I wish to register for the Asteroids 2001 meeting. Lit. __________________________ for myself and Lit. _________________for no._______ accompanying person(s). Name(s) of the accompanying person(s) _______________________________________________ Total Lit. _______________________________________ Please charge AMERICAN EXPRESS VISA MASTERCARD Number ______________________________________ Expiring _________________
AMERICAN EXPRESS VISA MASTERCARD
Number ______________________________________ Expiring _________________
I have already arranged for: Bank cheque Postal money order to be made to "Comitato Ceres 2001" and sent to the following address: Comitato Ceres 2001, c/o Osservatorio Astronomico di Palermo, Piazza del Parlamento 1, I-90134 Palermo, Italy. I am sending a copy of the bank/post office transaction to the attention of Donata Randazzo at the fax number 0039 091 233 444 (from the USA dial 011 39 091 233 444).
Bank cheque Postal money order to be made to "Comitato Ceres 2001" and sent to the following address: Comitato Ceres 2001, c/o Osservatorio Astronomico di Palermo, Piazza del Parlamento 1, I-90134 Palermo, Italy. I am sending a copy of the bank/post office transaction to the attention of Donata Randazzo at the fax number 0039 091 233 444 (from the USA dial 011 39 091 233 444).