5th COMPTON SYMPOSIUM Portsmouth, NH September 15-17, 1999 REGISTRATION FORM REMINDER: Your registration fee MUST accompany this registration form (with the exception of a bank transfer). If you are using mail, you may send a check, money order, or include credit card information. If you are using FAX you must include a credit card number and expiration date. Your registration cannot be processed without the fee. Submit to: Mail: Elizabeth Pentecost Division of Astronomy and Space Physics NRL and USNO Programs 300 D Street, SW Suite 801 Washington, DC 20024 FAX: 202-479-2613 First Name:___________________________________ Informal Name for Badge:______________________ Last Name:____________________________________ Affiliation for Name Tag:_____________________ Institution:__________________________________ (if different from Name Tag Affiliation) Address:______________________________________ Address:______________________________________ Address:______________________________________ City:_______________________ State:___________ Zip Code:__________ Country:__________________ Phone:________________ Fax:___________________ E-mail address:_______________________________ Payment Information ------------------- Check (Enclosed): _______ Money Order (Enclosed): _______ Bank Transfer: _______ Credit Card: _______ Mastercard____ Visa____ American Express____ Card Number: ________________________________ Expiration Date: ____________________________ Name on Card: ________________________________ Registration: Early Registration $240.00 ________ Early Student w/Proc $225.00 ________ Early Student w/o Proc $125.00 ________ Late - After Aug 15 $290.00 ________ Banquet: ______ tickets @ $50/ea. ________ ______ Lobster ______ Chicken ______ Vegetarian Total Fees: ________ Post-Conference Activity (please indicate number - for planning purposes only): Whale Watch ________ Compton Open ________