nanoparticles.org - Particles Conference Exhibitor Registration Form

Particles 2004 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	______________________________________

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: info@nanoparticles.org

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