| Sixth International Symposium on Beamed Energy Propulsion,
November 1 - 5, Doubletree Paradise Valley Resort, Scottsdale, Arizona, USA |
Please fill the fields and return this Registration Form and Fee to: |
| REGISTRATION FORM | American Institute of Beamed Energy Propulsion P.O. Box 1907, Madison, AL, 35758, USA Fax/Phone: 1-256-890-6286 ; E-Mail: secretary@aibep.org |
| Title and Name | (required) |
| Name on Badge | (if different) |
| Organization | (required) |
| Address | (required) |
| Address (cont.) | |
| City | (required) |
| State/Province | (required) |
| Zip/Postal Code | (required) |
| Country | |
| Phone | work home |
| FAX | |
| (for updates, etc.) | |
| Facilities | |
| AIBEP Member? | yes no |
| Dinner Interest* | yes no |
| Need extra copy of ISBEP 6 Proceedings? | yes no |
| Tour Interest** |
| BILLING:
All payments must
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Paying with
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| Name on Check
or Credit Card |
actual number below code for number n/a |
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| Credit Card Number**** | |||
| Credit Card Expiration Date | (MM/YY) | ||
| Credit Card Billing Address |
* Although one dinner seat is covered with registration fee, we still need to know how many seats to reserve by 11/1.
** The price of Thursday 11/05 Grand Canyon NP Bus Tour is not included
in the registration fee.
*** Please make check payable to the American Institute of Beamed
Energy Propulsion, Note: check payments are accepted for U.S. Banks only
****If you are feeling uncomfortable about sending your card number
with this form, you can fill this line with the letter code of your choice
and then send card number in separate message, give it by phone or mail
separately.
Regular registration ($350) includes Welcome Package, Welcome Reception (Sunday evening), coffee breaks between sessions and one seat at Symposium Dinner and Award Ceremony (Wednesday evening), as well as printed Program and one Book of Proceedings (including delivery and on-line access). Student/retiree registration covers the same set excluding the Book of Proceedings (the book can be ordered separately using extra copy pre-selling option).
Notes and comments. If you require handicapped facilities, please
specify.