Registration Form
Instructions
Please make checks (in US dollars drawn on a US Bank) payable to Duke University Wetland Center. Mail completed registration form with payment to: Seventh Symposium on Biogeochemistry of Wetlands, Duke University Wetland Center, Box 90333, Durham, NC 27708-0333 USA. Sorry, but we cannot accept credit cards or purchase orders.
This form is intended for your convenience. Please fill in all the required fields and then PRINT this form and mail with your payment. This is not an electronic registration - only a convenience for conference registrants.
YOU ARE NOT REGISTERED UNTIL YOUR CHECK FOR ALL FEES ASSOCIATED WITH THIS CONFERENCE HAS BEEN RECEIVED BY THE SYMPOSIUM ORGANIZERS.
Please use one registration form for each symposium participant.
Registrant's Information
First Name MI Last Name
Name as you wish it to appear on conference badge
Institution or Organization
Street Address 1
Street Address 2
City State/Province [State] -- USA States -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Deleware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota MIssissippi Missouri Montana Nebraska Nevada New Hampshire New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -- Canadian Provinces -- Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon Territories Postal/ZIP Code
Country
Phone Fax E-mail
Website
Fees
Please check the appropriate button and enter the amount in the box below.
Regular Participants:
Select appropriate fee Early Registration > Ends 2/15/01 > US$275 Standard Registration > 2/16/01-4/1/01 > US$375 Late Registration > After 4/1/01 > US$450
Student Participants:
Select appropriate fee Early Registration > Ends 2/15/01 > US$150 Standard Registration > 2/16/01-4/1/01 > US$195 Late Registration > After 4/1/01 > US$195
Please enter total from Fees section > US$
Optional Field Trip
Please check the button and enter the amount in the box below.
Field Trip
Description
Visit North Carolina's Unique Wetlands Cost includes one night lodging, transportation and breakfast; maximum 25 people
Please enter total from Field Trip section > US$
Hotel Accommodations
Please check the appropriate button(s) and enter the amount in the box below.
Reservations are at the R. David Thomas Conference Center on the Duke University campus.
Select number of nights 1 night > $115 2 nights > $230 3 nights > $345 4 nights > $460 5 nights > $575 6 nights > $690 7 nights > $905
Arrival date Departure date
Please enter total from Hotel Accommodations section > US$
TOTAL DUE
Please add all sections together and enter amount here > US$
Special Needs
Check here if you have a disability or physical limitation that may require special consideration so that you might fully participate in the Symposium. Please provide a detailed description of your needs below and a representative of the Symposium planning organization will contact you to see how we can accommodate your needs.
Signature
Please sign and date the registration form and return with your payment. Registration will only be accepted and considered complete if returned with payment enclosed. Failure to include payment will result in your registration form being returned to you.
Signature Date
