nanoparticles.org - Particles Conference Exhibitor Registration Form


	Particles 2003 Exhibitor Registration Please fill out (type before printing), print, sign this form, and submit via fax or mail (see bottom of this page).


Contact Person: Mr. Ms. Dr. Prof. (Check all that apply.)


Name				Telephone
Title				Fax


Organization


Address		E-Mail
Address


City/Town		State/Province


Zip/PostalCode			Country

Fee Due: Exhibitor Registration is US$1,800

Exhibitor Registration fees are non-refundable.
Choice of booths is made in order of payment.

Method of Payment:
(All payments must be in U.S. dollars)
Check Enclosed Checks must be drawn upon a U.S. bank.
Make checks payable to: Particles Conference (EIN 16-1565388)

Payment by wire transfer Wire payments to Manufacturers and Traders Trust Company (44 Exchange Boulevard, Rochester, NY 14612, USA), ABA Routing No. xxxx, Particles Conference Account No. xxxx; transfer fees not included in wire payment are due upon registration on site (contact conference office for Routing and Account Nos.).

Visa Master Card American Express

Card No. Exp. Date

Name on Card Signature
______________________________________

Payment by wire transfer	Wire payments to Manufacturers and Traders Trust Company (44 Exchange Boulevard, Rochester, NY 14612, USA), ABA Routing No. xxxx, Particles Conference Account No. xxxx; transfer fees not included in wire payment are due upon registration on site (contact conference office for Routing and Account Nos.).

*Visa Master Card American Express*

Please fax completed registration form to: (585) 482-7795 (No cover sheet required)


Or mail to: Particles 2003 *265 Clover Street* *Rochester, NY 14610-2246, U.S.A.*	*Questions?* *Call (585) 288-5913* *E-mail: query@nanoparticles.org*

Please fill out (type before printing), print, sign this form, and submit via fax or mail.

Card No.	Exp. Date

Name on Card	Signature	______________________________________