Registration Form Brochure

ATTENDEE PRE-REGISTRATION FORM SUBMIT BY 06/06/11 FOR DISCOUNTED RATES FAXED FORMS DUE BY: 06/20/11 REFUNDS GIVEN BEFORE 07/11/11 AMERICAN METEOROLOGICAL SOCIETY 19th Conference on Applied Climatology 36th Annual Meeting of the American Association of State Climatologists Practical Solutions for a Warming World: AMS Conference on Climate Adaptation 18-20 JULY, 2011 ASHEVILLE, NC NAME: WORK TEL #: AFFILIATION: WORK ADDRESS: FAX #: E-MAIL: IN CASE OF EMERGENCY, CONTACT #: 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 REVERSE) 1) PACKAGE CHOICE: (SEE BOX 2 ON PAGE 2) 2) ATTENDEE TYPE: (SEE BOX 2 ON REVERSE) ? Full-Week ? One-Day If One-Day Package, Indicate DAY OF WEEK: ADDITIONAL TICKETS Full week package includes a banquet ticket for Wednesday’s Luncheon. Number of Additional LUNCHEON tickets ($35 each): #___ Price $__ 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 19Applied/36AASC/1Adaptation Conference, 45 Beacon St., Boston, MA 02108 Fax: (617) 249-0272 REGISTRATION POLICY Submit this form with payment by 06/06/11 in order to receive the lower registration rate. Registrations received at AMS from 06/07/11 and through the conference dates will be processed at the higher rate (SEE RATES BELOW). After 06/20/11 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 11 July, 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 conferences, all conference materials, all coffee breaks, formal poster viewings, and 1 banquet luncheon ticket. ONE-DAY PACKAGE: includes: Admittance to all conferences and coffee breaks for one day. The banquet luncheon ticket is NOT included. ATTENDEE TYPE By 6 June 7 June and Onsite By 6 June 7 June and Onsite AMS FULL MEMBER; PROGRAM CHAIR & SESSION CHAIR $370 $410 $230 $270 AMS ASSOC. MEMBER, NONMEMBER SPEAKER/POSTER PRESENTER* $410 $450 $230 $270 NON-MEMBER $450 $490 $230 $270 RETIRED MEMBER $200 $240 $90 $130 AMS STUDENT MEMBER $200 $240 $60 $100 STUDENT NON-MEMBER $215 $255 $90 $130 BENEFITS to Pre-registering · DISCOUNTED RATES · RECEIVE WRITTEN CONFIRMATION · AVOID LONG ONSITE REGISTRATION LINES Become an AMS Member and pay less to attend AMS Meetings call now for Membership Information (617) 227- 2426 x 3912 and 3913