Registrant Information

______________________________________________________________________________________
Name (last name, first name, middle initial)
______________________________________________________________________________________
Affiliation
______________________________________________________________________________________
Address
______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________
Phone and fax numbers
______________________________________________________________________________________
E-mail address
______________________________________________________________________________________
Guest Name(s)

Registration Fees (All fees per person.)

	Registration Through 4/25/97	Registration After 4/25/97	Amount Enclosed
Participant	$275	$325	$_____________
Guest	$200	$250	$_____________
		TOTAL	$_____________

Do you have any physical or dietary restrictions? ___ Yes ___ No

If yes, briefly describe __________________________________________________________________

___________________________________________________________________________________

Method of Payment (Payment MUST accompany form.)
Cancellations with request for refunds will not be accepted after May 19, 1997.

• Foreign participants who have currency exchange problems may return this form and pay in cash at the meeting.
• Check or Money Order (Payable to the Lunar and Planetary Institute. Checks must be drawn on a U.S. bank.)
• VISA
• MasterCard
• American Express

_____________________________________________________________________________________
Card Number and Expiration Date
_____________________________________________________________________________________
Name as it Appears on Card
_____________________________________________________________________________________
Signature