Registration form for 59th Annual SWAN Meeting

Early registraton deadline: 16 March 2012

Name (as to appear on your badge):
I am willing to serve as a session moderator: Yes No
Institutional Affiliation:

Contact Information:
Address:
     
     
     
City:
State:
Postal Code:
Phone:
Country:
Email:

Regular registration $100.00 US $130.00 US after March 16     
Student registration $70.00 US$95.00 US after March 16     
Banquet $20.00 USNumber of tickets    
Picnic $20.00 USNumber of tickets    
SWAN 2012 T-Shirt ($15 US)
*Indicate number for each size ordered		  S
M
L
XL
Field trip to Natural Park Velo de Novia (transportation only)$10.00 USNumber of tickets    


Students only

Interested in a student workshop: Yes No

Interested in attending a student only social Saturday evening before the pre-banquet general social? Yes No

*