Symposium information: www.sjp.ac.lk/iiupst
Full Name: ______(First name for badge)______
University/Organization:______
Preferred Mailing Address: ______
City: ______State/Province: ______Zip/Postal Code: ______
Country: ______Telephone: (______)______Fax: (______)______
Email: ______
CONFERENCE FEES
1. Registration Fees Includes lunch, breaks, and proceedings.
Please check appropriate registration fee:
For Theme Sessions (April 3rd 2015)
postmarked paid
Before march 16th 2015 after march 16th 2015
University Rs. 4000.00 Rs. 5000.00
Industry Rs. 5000.00 Rs. 6000.00
International USD 100.00 USD 120.00
Student (with meals) Rs. 3000.00 Rs. 3000.00
Student (with meals) Rs. 1000.00 Rs. 1000.00
For Technical Sessions (April 4th 2015)
Before march 16th 2015 after march 16th 2015
For students Rs. 500.00 Rs. 500.00
For academic staff Rs. 1500.00 Rs. 2000.00
Industry Rs. 2000.00 Rs. 2500.00
International USD 50.00 USD 70.00
Rs. ______
If you received a scholarship, check r Do not pay a registration fee. Still complete this registration form.
Rs. ______
2. gala night or banquet dinner (Friday evening)
Indicate number of guests: ___ total number x Rs. 4500.00 Rs. ______
Print full name of guest(s):
total enclosed: Rs. ______
Count me for lunch: r Fri r Sat Vegetarian meals required: r Self r Guest(s)
Count me for Gala night or banquet dinner (Friday) r Vegetarian meal required: r Self r Guest(s)
Please list any Special Needs: ______
Cancellations/Changes and Refunds: Fees for missed meals, late arrivals, and early departures will not be refunded. Fees will be refunded, less a Rs. 500.00 processing fee, if cancellation or change resulting in a refund is received in writing no later than March 15th, 2015. After that date, fees are non-refundable. All refunds will be processed after the conference. Substitutions are allowed at no charge.
PAYMENT METHODS: Check or Money Order must be in U.S. funds or rupees payable to: Senior Treasurer, Chemical Society, University of Sri Jayewardenepura, Sri Lanka. Also money can be direct deposit to the People’s bank account at Gangodavila branch (Account number = 097-2-002-2-2334405) and post the bank slip to us. Cheques should be drawn in favor of the “Chemical Society, University of Sri Jayewardenepura”. There will be a $25.00 fee charged on checks returned by the bank due to insufficient funds. Registration confirmation/receipt and further information will be mailed.
Please check appropriate box: r Check r Money Order r Direct deposit
Card #:______Print Cardholder Name: ______
Please mail or fax completed registration form with payment to: IIUPST 2015 Symposium
Phone : (+094) 071-9809653 Dr. Dilru Ratnaweera
FAX : (+094) 011-2804206 Dept. of Chemistry
Email : University of Sri Jayewardenepura
Do not email credit card information because security cannot be guaranteed. Nugegoda, Sri Lanka
Please fax or telephone credit card information.