Registration Form

International Space Environment Conference 2001
Queenstown, New Zealand
July 23-27, 2001

Registration Deadline: May 23, 2001

 
Required fields are shown in red.

Name    

Address  

Email    

Phone        Fax   

Name for Badge     

Affiliation for Badge    

Are you a student? :   

Registration Fees

Conference Registration Fee:

Please check one box

Early Registration (received on or before April 2, 2001)

$350 US

Late Registration (received after April 2, 2001)

$400 US

Accompanying Persons:

Please register the number of accompanying persons that will be attending the conference dinner.

Number of Accompanying Persons (attending the conference dinner)
$50 US each

Clicking the "Send Form" button will email the above information to the conference administrator and will return a web form which can be printed and either faxed with credit card information (the preferred method of payment) or mailed with a check.