Mail-in/fax registration form

If you wish to register for the DMT '00 meeting in Lexington, Ky., please print this form and mail or fax to:

University of Kentucky/OISTL
107 Mining ∓ Mineral Resources Building
Lexington, KY  40506-0107
Fax: (606) 257-2173

Registion fee: $45.00
Please make checks payable to "University of Kentucky."

Name:________________________________  Name for Badge:___________________________

Affiliation:_______________________________________________________________________

Business Address:_________________________________________________________________

City:_____________________  State:__________ Zip:___________  Phone (_____)____________

Fax (_____)_______________   E-mail:________________________________________________

Would you like to present:   poster       paper

Payment Information

Check enclosed  Bill my organization  Electronically transfer funds         (*Please tag electronic funds as 'DMT 2000' when transferring)    Charge $_____________  to my :    Visa     MasterCard ________________________________________________ Cardholder's name (please print) Card # _______________________________  Exp. date ____________ _______________________________________________ Cardholder's signature

Questions?  Call Julie Back at (606) 257-4634 or e-mail: jdback00@pop.uky.edu

Please indicate any special computer/presentation needs you will have:________________________

_____________________________________________________________________________