LEB 99 Workshop
Registration Form

September 20-24, 1999 - Snowmass, Colorado, USA

Early Bird Registration Deadline: Sunday, August 15

Hotel Reservation Deadline: Thursday, August 19

To register for this workshop, please complete the information requested below and SUBMIT.

You may also use the print button of your browser to print a copy to fax or mail to the conference secretariat. Please retain a copy for your own records.

Upon receipt of your registration form (electronically, by mail or fax) you will receive an e-mail confirmation.

Housing reservations must be made independent of this registration form. Information can be found on the Hotel link

Workshop Registration:

Title 
First Name 
Last Name 
Name Preferred on Badge 
 
Institution 
Address1 
Address2 
City  State/Province 
Zip/Postal Code  Country 
 
Telephone  Fax 
E-Mail 
 
Names of accompanying guests (blank if none)
Guest 1 
Guest 2 
Guest 3 


Registration Fees:

REGISTRATION FEE
$250 US Early Bird (by August 15)
$300 US Standard (after August 15)
 

Method of Payment:
Check, purchase order or credit card information must accompany registration. Checks & Purchase Orders need to be made out to: University of Wisconsin. Please click on payment option. If you elect to send credit card information on-line, please note that this site is NOT on a secure server.

Check No.
Purchase Order No.
VISA
MasterCard

CREDIT CARD NUMBER

Expiration Date (MM/YY)
Traveler's Check - (Pay Upon Arrival)
Cash - (Pay Upon Arrival)
Credit Card (Pay Upon Arrival)
Please note that the conference does not accept American Express Credit Cards


Arrival and departure information. If you wish, enter some or all of the following arrival and departure information.

Arrival date: September
Departure date: September
Arrival Flight information:
Airline:
Flight number:  
Airport: (i.e. Aspen, Denver)  


Please note that this is not a secure server.
To check information, please click here.
To register on-line, please click here.
To get a printable version of this form for mailing or FAXing, please click here.
To reset the form, please click here. 
Mail Registration To:
LEB99 Workshop
c/o Aimee Lefkow
Department of Physics
1150 University Avenue
University of Wisconsin-Madison
Madison, Wisconsin USA 53706

If you are paying by
purchase order, you may
fax this registration to:
(608) 263-0800		 REGISTRATION CONFIRMATIONS - Confirmations will be e-mailed upon receipt of form.

CANCELLATION POLICY - Cancellations may be requested and must be postmarked or faxed by September 1, 1999. A $50 service charge will be deducted from all refunds. After September 1, no refunds will be given.

SPECIAL NEEDS - Accomodations for persons with disabilities will be made if requested and possible. Call (608) 263-2267.
QUESTIONS - Call (608) 263-2267; fax (608) 263-0800 or E-mail LEB 99 at leb99@hep.physics.wisc.edu


LEB 99, Fifth LHC Electronics Workshop, Snowmass, Colorado

main info | registration | program | hotel | secretariat | local info | whats new | LEB 98


Contact: LEB99 Secretariat

<Revision date: Thu Apr 1, 1999>

© University of Wisconsin, LHC Electronics Board, 1999.