Paper Pre-Registration Form for Meeting Brochure

ATTENDEE PRE-REGISTRATION FORM SUBMIT BY 7/22/11 FOR DISCOUNTED RATES FAXED FORMS DUE BY: 9/14/11 REFUNDS GIVEN BEFORE 9/9/11 35TH CONFERENCE ON RADAR METEOROLOGY 26-30 SEPTEMBER 2011 THE OMNI WILLIAM PENN HOTEL PITTSBURGH, PA NAME:___________________________________ WORK TEL #: NAME: AFFILIATION: WORK ADDRESS: FAX #: IN CASE OF EMERGENCY, CONTACT #: E-MAIL: AFFILIATION TYPE: (See Box 1 on reverse) DO YOU WANT YOUR NAME PUBLISHED ON THE ATTENDANCE LIST? (See reverse) ? YES ? NOGUEST/HOTEL INFORMATION (FOR AMS INFORMATION ONLY; ATTENDEE IS RESPONSIBLE FOR MAKING OWN HOTEL RESERVATION) ARE YOU BRINGING A GUEST? ? YES ? NO If yes, NAME OF YOUR GUEST (FOR BADGE): HOTEL NAME ARRIVAL DATE: DEPARTURE DATE: ? SINGLE or ? DOUBLE REGISTRATION PACKAGES (SEE BOX 2 ON PAGE 2) 1) PACKAGE CHOICE: (SEE BOX 2 ON PAGE 2) 2) ATTENDEE TYPE: (SEE BOX 3 ON REVERSE) ? Full-Week ? One-Day If One-Day Package, Indicate DAY OF WEEK: 3) GUEST TICKET TO CLIPPER CRUISE EVENT ($65) (Does NOT include a ticket to the Clipper Cruise Event.) (One ticket is included in the full-week registration package.) _______ # of Guest Tickets TOTAL CONFERENCE FEES AND METHOD OF PAYMENT ? CHECK ? PURCHASE ORDER #: REGISTRATION FEE: $ . Additional Tickets Fees: $ . ? CREDIT CARD (? MasterCard ? VISA ? AMEX) TOTAL CONFERENCE FEES $______________________ Card # ____________________________________________ Expiration Date: ________________________ Name on Credit Card: Street Address as it appears on Credit Card Statement: City: ________________________________ State/Prov.______________ Zip/Postal Code: _________ MAIL TO: AMS 35 RADAR CONFERENCE, 45 Beacon St., Boston, MA 02108 Fax: (617) 249-0272 REGISTRATION POLICY Submit this form with payment by July 22, 2011 in order to receive the lower registration rate. Registrations received at AMS from July 23, 2011 and through the conference dates will be processed at the higher rate (SEE RATES BELOW). After September 14, 2011, please register at the meeting or On-line. Payment may be made with check, purchase order (HARD COPY REQUIRED) or credit card (MASTERCARD/VISA/ AMERICAN EXPRESS). FAXED registration forms must be accompanied by payment (PO OR CREDIT CARD # ONLY). Refunds are given (LESS A $25 FEE) if cancellation is received by September 9, 2011 (NO REFUNDS THEREAFTER). Registration will not be processed without payment. Confirmation of registration will be e-mailed. ATTENDANCE LISTS The AMS will be making the attendance list from this meeting available to attendees and exhibitors (if participating). The list will be provided in electronic form only and will include attendee name, affiliation (if provided), address, city, state, zip code, and country. No phone, facsimile, or e-mail address will be provided on the list. To request a copy of this list, inquire at the AMS Registration Desk on-site. BOX 1: SELECT ONE OF THE FOLLOWING AFFILIATION TYPES AND FILL IN ON THE REVERSE: • GOVERNMENT • PRIVATE SECTOR • STUDENT • UNIVERSITY BOX 2: SELECT REGISTRATION PACKAGE AND YOUR ATTENDEE TYPE AND FILL IN ON THE REVERSE FULL-WEEK PACKAGE includes: Admittance to all conference sessions, all conference materials, all coffee breaks, formal poster viewings, receptions and 1 banquet ticket. ONE-DAY PACKAGE: includes: ONE CALENDER DAY PASS Admittance to all conferences and coffee breaks for one calendar day. (Does NOT include a ticket to the Wed. Clipper Cruise Event. Tickets may be purchased separately.) ATTENDEE TYPE By 22 July After 22 July By 22 July After 22 July AMS FULL MEMBER; PROGRAM CHAIR OR SESSION CHAIR $455 $495 $255 $295 AMS ASSOC. MEMBER, NONMEMBER SPEAKER/POSTER PRESENTER $495 $535 $255 $295 NON-MEMBER $540 $580 $255 $295 RETIRED MEMBER $205 $245 $90 $130 AMS STUDENT MEMBER $180 $220 $60 $100 STUDENT NON-MEMBER $210 $250 $90 $130