To register send the completed registration form with remittance to Lesia Linkous, Division of Polymer Chemistry, Inc., Virginia Tech, 410 Davidson Hall, M.C. 0279, Blacksburg, VA 24061, Phone: 540-231-3052, Fax: 540-231-2588, e-mail: lesiar@vt.edu.

After May 7, 2007 there will be a late fee.

Use the on-line registration form (preferred) or the form below. Go to Macromolecules-IUPAC.

REGISTRATION FORM
IUPAC and ACS Conference on
Macromolecules for a Safe, Sustainable and Healthy World
2nd Strategic Polymer Symposium
June 10-13, 2007
Polytechnic University - Brooklyn, New York, USA

Prof.   Dr.   Mr.   Ms.   Mrs.   Miss   
Name
Organization
Mailing Address

City                                 State         Zip
Country
Phone                                Fax
E-mail

____$630 Member of POLY or IUPAC
____$700 Non-Member
____$225 Student Member of POLY or IUPAC
____$250 Student Non-Member
____$225 ACADEMIC Speaker Member of POLY or IUPAC
____$250 ACADEMIC Speaker Non-Member
____$225 Guests
          Name(s):
____$50 Late Fee (after May 9, 2007)

Total Amount Due: $

Payment by:____Check____Credit Card

VISA or MASTERCARD or AMERICAN EXPRESS      Exp. Date

Account #

Signature

____Yes, I plan to contribute a poster

             Title:

             Author :