Conference on Early Mars:  Geologic and Hydrologic Evolution,
Physical and Chemical Environments, and
the Implications for Life

April 24-27, 1997
Houston, Texas

PREREGISTRATION FORM

Please abbreviate long names and affiliations the way you would prefer to see them on your badge.

NAME:  __________________________________________________________________________________

AFFILIATION:  ____________________________________________________________________________

ADDRESS:  _______________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

PHONE:  _________________  FAX:  __________________  E-MAIL:  _______________________________

Badge Name:  ________________________________  Affiliation:  ____________________________________

Badge Name:  ________________________________  Affiliation:  ____________________________________

Payment must accompany form. Foreign participants may
return this form and pay in cash at the meeting.
Cancellations with requests for refunds will not be accepted after April 21, 1997.

______	@	$115.00	Professional Registration		$  ______
______	@	$95.00	Student Registration		$  ______
				Total Enclosed	$  ______

Please Indicate Method of Payment

____  Check or money order payable to the LPI     ____  AmEx      ____  VISA      ____  MasterCard
          (checks must be in U.S. dollars and drawn on a U.S. bank)

Card Number  _________________________________________  Expiration Date  __________________________

Name as It Appears on Card (Please Print)  ___________________________________________________________

Signature  _______________________________________________

RETURN THIS FORM TO:  Conference on Early Mars Registration, Lunar and Planetary Institute, Publications and Program Services Department, 3600 Bay Area Boulevard, Houston TX 77058-1113. For registration information contact the LPI Publications and Program Services Department; phone:  281-486-2142; fax:  281-486-2125; e-mail:  tanner@lpi.usra.edu.

Back to Final Announcement