The Society of Rheology 77th Annual Meeting
October 16 - 20, 2005  —  Vancouver, British Columbia, Canada

Annual Meeting / Short Course Registration Form
    
Please type appropriate information and then print form. Mail or fax the form or e-mail a PDF scanned version of the form to: The Society of Rheology 77th Annual Meeting, c/o Savvas Hatzikiriakos, Department of Chemical and Biological Engineering, University of British Columbia, 2216 Main Mall, Vancouver, BC V6T 1Z4, Canada. Fax: (604) 822-6003. E-mail: hatzikir@interchange.ubc.ca.
Last Name         
First Name        Middle Initial
Institution         
Dept/Div           
Work Address  
City, State, Zip 
Country             
Phone                 Fax 
E-mail               
Meeting Registration: Meeting registration includes access to all technical sessions and the vendor display, the program and abstract booklets, receptions, coffee breaks, and refreshments at the poster session. The registration fee does not include the Monday Banquet, which is subject to limited seating. Please indicate the number of tickets you are purchasing for this event. Registration fee and cost of banquet ticket are in U.S. dollars. Cancellations received in writing by September 2, 2005 will be subject to a $30 administrative charge. No refunds will be granted after that date.
Check the appropriate box: Through 9/2/05 After 9/2/05 Meeting Registration Fee
  $
  
Monday Banquet Tickets
  $
  
Subtotal
  $
Member: Member No. $130 (USD) $165 (USD)
Non-Member (incl. membership for 2006)
       decline membership (same reg. fee)		 $185 (USD) $245 (USD)
Student Member: Member No. $40 (USD) $50 (USD)
Student Non-Member
      (includes student membership for 2006)		 $65 (USD) $85 (USD)
Retired Member: Member No. $40 (USD) $50 (USD)
Monday Banquet Ticket -  indicate number of tickets:
    Meat,  Fish,  Vegetarian		 $65 (USD) each $75 (USD) each
 
Short Course Registration: Short course registration includes a complete set of course notes. Registration fees are in U.S. dollars. Cancellations for the short course received in writing by September 2, 2005 will be refunded minus a $30 administrative charge. Cancellations after September 2, 2005 will only be refunded if the course is overbooked and the seat is refilled (again, subject to a $30.00 administrative charge).
Check the appropriate box: Through 9/2/05 After 9/2/05+ Short Course
Registration Fee
  $
 
Subtotal
  $
Member: Member No. $450 (USD) $550 (USD)
Non-Member (incl. membership for 2006)
       decline membership (same reg. fee)		 $505 (USD)* $605 (USD)*
Student Member: Member No. $250 (USD) $325 (USD)
Student Non-Member
      (includes student membership for 2006)		 $275 (USD)* $350 (USD)*
* Non-members who are registered to attend the 77th Annual Meeting may register for the short course at the member rates.
+ Although every effort will be made to provide course materials for all participants at the start of the course, those registering late may not receive course materials on time.
Please indicate number of non-attendees who will accompany you - 
 
Method of Payment:
Check or money order
 (payable to The Society of Rheology)
 
You can pay with credit card by registering online.
Total Enclosed
  $
Registrations will be confirmed by e-mail. Attendees will pay their own room, tax, and incidentals incurred by them at hotels. The federal tax identification number of The Society of Rheology is 13-620-3476.
Special
Requests   		For participation in the meeting/short course
 For dietary requirements
Registrant Application for Membership in The Society of Rheology:  Please complete the rest of the form to activate the membership included in non-member registration fee. Applicant for student member should attach a copy of student ID.
Affiliation Type (check the most appropriate):          Academia          Industry          Government
   
The work address you entered earlier will appear in the membership directory. Publications will also be mailed to your work address. If you prefer to have publications mailed to a different address, please enter it below:
Mail Address    
City, State, Zip 
Country             
   
Members receive the Rheology Bulletin, the Journal of Rheology (6 issues), and Physics Today (12 issues). A member subscription to the Journal of Rheology is only for your personal use. By your signature below, you agree not to loan or give any issues of this journal to a library or other lending institution without written permission from The Society of Rheology.
Signature (required):           Date: