ICEST2012 Registration Form

6th International Conference on Environmental Science and Technology (ICEST2012)

June 25-29, 2012, Hilton Hotel, Houston, Texas 77060, USA

(If you register online at http//www.AASci.org/conference/env/2012/registration.html, please DO NOT fill in this form)

PLEASE PRINT

Last Name (Family Name) ______

First Name (Given Name) ______M.I.______

Highest Degree, Title ______

Department ______

Institution ______

Address (Street Number and Name, Mailing Address) ______

City ______State/Province ______

Postal/Zip Code ______Country ______

E-mail ______

Phone ______Fax ______

(Please check an appropriate box below)

By 31 March, 2012 / By 25 May, 2012 / After 25 May, 2012 / On-site (25-29 June, 2012)
Standard / □ US$690 / □ US$790 / □ US$870 / □ US$890
Full-time Student / □ US$410 / □ US$430 / □ US$450 / □ US$470

All presenters and session chairs are expected to register before the conference with standard fees. A copy of current student ID is required to receive the student fee.

To confirm your registration, payment is required (Please check one or more appropriate boxes below):

□ Wire Transfer (Please contact us before transferring funds)

□ Money Order; □Check (accept US checks only, payable to the American Academy of Sciences and reference the Environmental Conference).

□Visa □MasterCard

Credit Card Number______Expiration Date (mm/yyyy) ______/ _____

3-digit Card-Verification-Code (CVC) on the back of your credit card ______Card Holder______

Signature of Cardholder ______Paid U.S. $ ______

The registration fee is available for refund only if the cancellation is received by May 25, 2012. No exceptions apply, but all paid registrants will still receive the materials covered by the registration fee regardless of attendance. Substitutions are accepted however; advance notice would be greatly appreciated. If AAS cancels the event due to circumstances beyond AAS’s reasonable control including but not limited to acts of God, government emergency, labor strikes, acts of war, and/or unavailability of the event facility, AAS will refund to attendee his/her paid registration fee minus a portion of the event costs acquired by AAS. This refund will be the attendees’ exclusive remedy and AAS’ only liability for cancellation of the event for reasons described above.

Registration Methods:

□Online Via Web:

http://www.AASci.org/conference/env/2012/

registration.html

□Fax: 713-776-9767

□E-mail:

□Mail: Environmental Conference

American Academy of Sciences

9720 Town Park Dr. Ste 18

Houston TX 77036, USA