PAG 2010 Attendee Registration

Hyatt Regency Bellevue, Washington, USA September 19-22, 2010 PARTICIPANT INFORMATION Last Name: ______________________________ First Name: ________________________ M.I. _____ Organization: _________________________________________ Position: ________________________ Address: _________________________________________________ ________________________________ Street City _________________________________________________ _______________________________ State Country Postal Code Phone: _________________________________________ Fax: _________________________________________ E-mail: _________________________________ Names of Accompanying Person(s): ________________________ REGISTRATION FEES On or Before June 11, 2010 After June 11 & On-Site Payment IOA membership (Discounted rates to all IOA conferences and publications and subscription to Ozone Science & Engineering and Ozone News.) see www.io3a.org **See IOA website for membership fees** Type of membership____________________ ________ Member - Full Registration - Add $150 for Non-member (Incl. Technical sessions, proceedings, 2 receptions, 2 lunches, & banquet) $450 $550 ________ Member - Student Full Registration - Valid Student ID required. (Incl. Tech. sessions, 2 reception & 2 lunches) - Add $75 Non-member $225 $275 ________ Member - One Day Registration, Monday __ Tuesday __ (Includes Tech. sessions, exhibits and lunch) - Add $75 for Non-Member $225 $275 ________ Exhibits Only, Monday __ Tuesday __ $25/day $30/day ________ Sunday Ozone Basics Workshop - Add $50 Non-member $175 $175 ________ Wednesday Operations Workshop $130 $130 ________ Wednesday Technical Tour: Municipal Water (Includes transportation, box lunch & optional Airport drop-off) $50 $70 ________ Accompanying person registration, with Full Registration (Includes 2 receptions, all exhibits and banquet. Lunches purchased separately. Accompanying persons that wish to attend technical sessions must purchase a full registration.) $175 $225 ________ Additional Sunday Opening Reception Tickets Qty: ____ $55 $70 ________ Additional Monday Exhibitor Reception Tickets Qty: ____ $55 $70 ________ Additional Tuesday Banquet Tickets Quantity: ____ $80 $95 ________ Additional Lunches, Enter Quantity per Day: M __ T __ $50 $60 ________ Shaded Items are Optional Additional Programs TOTAL: ________ METHOD OF REGISTRATION PAYMENT Registration forms MUST be accompanied with payment to be processed. Personal Check Company Check Make checks payable to IOA - PAG in U.S. Funds. MasterCard/Visa American Express Discover Billing Address_________________________________________________________________________________________ Credit Card No. ____________________________________ Expiration Date ______________ Signature______________________________________________ Cancellation policy: Full refunds will be provided if notified before July 23, 2010; a 50 percent refund will be provided if notified by August 27, 2010; and no refund will be provided after August 27, 2010. Dr. Ms. Mr. _____ Mrs. Pan American Group Regional Conference A T T E N D E E R E G I S T R A T I O NTo submit registration, complete this form and fax/mail with payment to: IOA - PAG 2010 Conference PO Box 28873 Scottsdale AZ 85255 Fax: 480-473-9068 infO3zone@io3a.org Visit http://www.io3a.org to register online Questions? Call 480-529-3787 Ms: undefined: Last Name: First Name: MI: salutation: undefined_2: Organization: Position: Address: City: State: Country: Postal Code: Phone: Fax: Email: Names of Accompanying Persons: Discounted rates to all IOA conferences and publications and subscription: Member Full Registration Add 150 for Nonmember: Incl Tech sessions 2 reception 2 lunches Add 75 Nonmember: Includes Tech sessions exhibits and lunch Add 75 for NonMember: Exhibits Only Monday: Sunday Ozone Basics Workshop Add 50 Nonmember: Wednesday Operations Workshop: Wednesday Technical Tour Municipal Water: Accompanying person registration with Full Registration: Additional Sunday Opening Reception Tickets: Additional Monday Exhibitor Reception Tickets Qty: Additional Tuesday Banquet Tickets: Additional Lunches Enter Quantity per Day: Qty 1: Qty 2: Quantity: Personal Check: Company Check: See IOA website for membership fees: 550: 275: 275_2: 30day: 175: 130 1: 130 2: 225: 1: 2: 3: 4: TOTAL: MasterCardVisa: American Express: Discover: Billing Address: Credit Card No: Expiration Date: Monday Qty: Tuesday Qty: