REGISTRATION FORM

Messiah College — August 5–8, 2005

Payment for on-line registration must be made through the PayPal link provided below. If you do not wish to use PayPal, you must fill out a paper registration form and mail in the form and payment.

Please fill out a separate form for each person registering.
Your meeting badge will contain your name, city, state, and major field.
The fields marked with a * are required. You will not be allowed to submit the form until they are filled out.

* First Name: Middle Name or Initial: * Last Name: Suffix:
* City: * State:
Major Field:
Affiliation:
* Mailing Address (1):
Mailing Address (2):
* City: * State: * Zip: Country:
E-mail:
Telephone:

Registration fee (per person): Deadline for registration is June 20, 2005. We cannot guarantee lodging or meals after deadline.

Type of Registration:
Registration Total: $

PLEASE NOTE: Any change in registration information such as meals, housing, or field trips after June 20, 2005 will result in a $50 fee.

Lodging and meal package. Special accommodations cannot be guaranteed.

Check if you need handicap accessibility Check if you require first floor lodging

Lodging and meal package:
Conference Package: $

Please attempt to match me with a roommate (cannot be guaranteed).
I would like to share a room with:

Accommodations are available for extra nights

Extra accommodations:
Additional Lodging Total: $

Additional Meals

Thursday Lunch
$ 9.25
Thursday Dinner
$10.25
Friday Breakfast
$ 5.25
Friday Lunch
$ 9.25
Monday Dinner
$10.25
Tuesday Breakfast
$5.25
Additional Meals Total: $

Commuter package:

Includes commuter fee, Friday dinner through Monday lunch (lunches and dinners only) $102
The Commuter Package does not include the meeting reistration fee.
Commuter Package Total: $

Field Trips:

See brochure for details. Please check which field trips you would like.

1. Gettysburg Battlefield $38.50
2. Geology Field Trip $10.00*
3. Biology Happening $10.00*
4. Spouse Hershey Chocolate World $10.00
5. Lancaster, Amish Country $ 45.00
       *includes a bag lunch
Field Trip Total $

Messiah Shuttle Service: $14 each way/per person.

Shuttle Service:
Shuttle Total $

Donation:

A $100 tax-deductible donation would help a student or early career scientist attend
this meeting through our Student and Early Career Scientists Scholarship fund.

Donation Total: $

TOTAL AMOUNT ENCLOSED $

Comments:

Your registration will not be valid until payment is received.
Please click on the PayPal button below to make your payment before submitting your registration.
Click on the Submit button when you are ready to submit your registration.

    

Payment for on-line registration must be made through the PayPal link provided below.
If you wish to pay for multiple registrations with a single PayPal payment, you may do so.
Please make a note in the Comment field on this form and in the Instructions field on the PayPal form.
If you do not wish to use PayPal, you must fill out a paper registration form and mail in the form and payment.

Click on the PayPal button and enter the amount
that appears in the TOTAL AMOUNT ENCLOSED box on your registration form.