Digital Mapping Techniques 2010 Meeting Registration Form
REGISTRATION FORM
RegistrationYour registration is not valid until payment is received. No on-site registration.
Attendee Information
Preferred name, full name and affiliation will appear on name badge. Print legibly or type.
Name:
First Name / MI / Last Name (Surname)
Registrant’s preferred first name for badge
Institution/Affiliation:
Contact Information
Address:
Street Address
City / State / Zip Code / Country
Phone: / ( ) / Fax: / ( )
Please include area, city and country codes / Please include area, city and country codes
Email:
Required for confirmation purposes, participation roster and receipt.
If an email address is not provided the above information will be sent via regular mail.
Registration Fees
Payment by
April 19, 2010
*if by mail, postmarked by April 19, 2010 / Payment after
April 19, 2010
Registration Fee / Early registration is over. / $150
Registration Total / $
CANCELLATION POLICY: All Cancellations must be received before Monday, May 3, 2010. Cancellations are processed as soon as possible and are subject to a $30 cancellation fee. No refunds will be provided after Monday, May 3, 2010. However, you are welcome to send someone else in your place.
Events
Date / Event / Attendance
Sunday, May 16 / Reception – Embassy Suites, Sacramento – River City Ballroom
For spouse/guest tickets, contact / Yes No
Monday, May 17 / Dinner at the Delta King Hotel – Sacramento, CA
For spouse/guest tickets, contact / Yes No
Conference Questions
1. Please check. At this conference: I would like to give a talk*
I would like to present a poster*
*(to discuss getting on the agenda, please contact Dave Soller at )
2. Do you have any special dietary needs? Yes No Explain:______
3. Do you have any other special needs? Yes No Explain:______
Payment Information
Enclosed is my check/money order made payable to “DMT ‘10”
Payment made online with credit card ending in (last four digits) --
AMasterCard Total Amount Due: $
Submit your completed registration form and payment to the address below:
(If payment is made online, registration form can be sent by mail, e-mail, or fax).
California Geological Survey
345 Middlefield Road, MS-520
Menlo Park, CA 94025
Attn: DMT 2010
Fax: (650) 688-6329 – Attn. DMT 2010
Registration Confirmation: Once your registration form has been processed, you will receive confirmation by Email. If you have not received an Email confirmation in ten (10) business days after submitting your registration form, please contact the California Geological Survey at (650) 688-6327 or (916) 324-7324 or by email at to inquire on whether your completed registration form was received.
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