DOWNLOADABLE PREREGISTRATION FORM

You MUST return this form to LPI no later than October 30, 1998, to avoid the $20.00 late fee.
Please abbreviate long names and affiliations the way you would like them on your badge.

NAME:  ________________________________________________________________________

AFFILIATION:  _________________________________________________________________

ADDRESS: _____________________________________________________________________

_______________________________________________________________________________

PHONE:  _________________  FAX:  _________________  E-MAIL:  ______________________

GUEST NAME: __________________________________________________________________

O  Please check here if vegetarian meals are required.

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 November 20, 1998.

____ × $260.00Professional Registration through 10/30/98$_________
____ × $280.00Professional Registration starting 10/31/98$_________
____ × $180.00Student Registration through 10/30/98$_________
____ × $200.00Student Registration starting 10/31/98$_________
____ × $150.00Guest Registration starting 10/31/98$_________
____ × $170.00Guest Registration starting 10/31/98$_________
____ ×      $0.00Working Press$_________
Total Enclosed$_________

Please Indicate Method of Payment

OCheck or money order payable to the Lunar and Planetary Institute
(checks must be in U.S. dollars drawn on a U.S. bank).
OAmExO VISA O MasterCard

Card Number  _______________________________________  Expiration Date  ____________________

Name as It Appears on Card (PLEASE PRINT)  ______________________________________________

Signature  ____________________________  Authorization Code (LPI USE ONLY)  ________________

RETURN THIS FORM BY October 30, 1998, TO   Origin of the Earth & Moon, 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).


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