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Print this form, fill out, and submit with your check
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Mail-In Registration Form for PTG Meeting on
Oct 21, 2010
Name
_________________________________ Affiliation ______________________________
E-mail
___________________________________________ Phone ______________________
__ Please
do not share my name and contact information with other participants.
__ ACS Member $40; __ Non-member $50; __ Student $25.
Must be in by
Oct 7, 2010.
After
Oct 7, 2010:
__ Member
$45; __ Non-member
$55; __ Student
$30
__ I will
submit a poster: Title
____________________________________________________
Make check payable to
“NJACS-Polymer Group”
and mail to
Dr. Willis B. Hammond
Treasurer, NJACS-PTG
128 Center Ave
Chatham, NJ 07928