60TH METEORITICAL SOCIETY MEETING

REGISTRATION FORM

Please return by July 7, 1997, to 60th Meteoritical Society Meeting, Publications and Program Services Department, Lunar and Planetary Institute, 3600 Bay Area Boulevard, Houston TX 77058-1113, USA. Phone:  281-486-2142; fax:  281-486-2125; e-mail:  tanner@lpi.usra.edu

Last Name:  _________________________________ First Name:  __________________________________

Affiliation:  _______________________________________________________________________________

Address:  ________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

Phone:   ___________________  Fax:  __________________  E-mail:  _______________________________

I will be accompanied by ___ guest(s). Name(s):  ___________________________________________________

REGISTRATION FEES (per person, in U.S. dollars)

No. of Persons Amount Enclosed
Member ______ @ $305 = __________
Nonmember ______ @ $335 = __________
Student member ______ @ $205 = __________
Student nonmember ______ @ $235 = __________
Guest ______ @ $175 = __________
TOTAL ENCLOSED__________

Please Indicate Method of Payment

Check or Money Order ___ (Make payable to the LPI; must be in U.S. dollars drawn on a U.S. bank)

MasterCard ___ VISA ___ American Express ___ Expiration Date:  _________  Card Number:  ____________________________

Name as It Appears on Card:  ________________________________________________________________

Signature:  _______________________________________________________________________________

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