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Interdisciplinary Transport Phenomena Conference VII:
Fluid, Thermal, Biological, Materials and Space Sciences
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First Name:
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Middle Initial (optional):
Surname:
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Salutation:
Mr.
Ms.
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Gender:
*
Male
Female
Nickname for Badge:
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Organization, Institution, or Company
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Street Address
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:
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Address
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City:
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State or Province:
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Postal Code:
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Country:
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Telephone Number:
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Fax Number:
E-Mail Address (one only):
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Preferred Contact Method:
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Email
Fax
Mail
Arrival Date:
*
Departure Date:
*
Emergency Contact's Name:
Emergency Contact's Phone:
Type of Accomodations
(select one)
*
Early-Bird Fees
(by July 31, 2011)
Fees
(after July 31, 2011)
Conference Participant (single occupancy).
$1565
$1710
Conference Participant (hotel-accommodation not included, daily lunch and dinner included, banquet included).
$985
$1130
Conference participant plus a guest not attending conference, sharing a room. Guest fee covers daily dining with the conference participants.
$2040
$2185
Bona-fide Graduate Student sharing a room with another participant.
$1115
$1260
Bona-fide Graduate Student (hotel-accommodation not included, daily lunch and dinner included, banquet included).
$685
$830
Non-student sharing a room with another conference registrant.
$1275
$1420
Special Neeeds:
Wheelchair Accessible
Vegetarian Meals
Food Allergy
Other (specify)
Method of payment
(select one)
*
Payment by credit card.
Form for payment by credit card.
Check payable to University of Southern California and drawn on a U.S. bank in U.S. dollars is being sent.
Duly authorized, signed purchase order is being sent.
Wire transfer in US$ to USC.
Please add $30 to defray bank fees on payments made by wire transfer.
Please reference your full name and
Interdisciplinary Transport Phenomena Conference VII
on your transfer.
Please fax a copy of your wire transfer papers to +1 (213)740 7774, attn: Silvana Martinez-Vargas, to assist in tracing your transfer.
More informaton on wire transfers to USC.
Check or purchase order in process.
For payment in progress by check or purchase order we will contact the person listed below to confirm the payment proccess is in progress:
Contact's Name:
Contact's Phone:
Contact's Fax:
Contact's Organization:
Click the submit button to register for the conference.
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