A Cultural Renewal of Science
July 31 and
at The
Please print:
Name: _________________________________________________ Date: _______________
Address: ___________________________________________________________________
Telephone: _______________________ Email address: ______________________________
Title & organization name: _______________________________________________________
Total amount of check or money order enclosed (mark fees below)*________________________
How did you find out about the conference: __________________________________________
Thursday, July 31 sessions and 2 meals @ $25
$ ___________
Thursday hot breakfast at cafeteria @
$8
$ ___________
Friday, August 1 sessions and 2 meals @ $25
$ ___________
Friday hot breakfast at cafeteria @
$8
$ ___________
Conference registration fee @ $5 per
person
$ 5.00
*TOTAL $ ___________
After
Friday July 18, email registration, and pay fees on site
Check or money order only, thank you
Questions or comments: info@iapweb.org
Mail Registration Form and fees to:
The Institute for Advance Physics
P.O. Box 15030
Baton Rouge, LA 70895-5030