Registration Form

Please fill all the fields carefully. Once submitted, you will receive an e-mail with confirmation number. Cancelations after May 1st will be charged a 10% cancelation fee.

First Name

Last Name

e-mail address:






Registration fee type

Industry - $500.00

Government - $400.00

Academia - $400.00

Student - $200.00

Affiliation: Accompanying Person/s
x $150.00
Conference Dinner
x $50.00
Credit Card Type:
Visa      Mastercard American Express (if invited speaker please type invited speaker in card number field and 00/00 in Expiration date)
Credit Card Number: Expiration Date:
 
 

    

 
University of Arizona

Congress Office
Fax:(225)578-0276
piccongress@lsu.edu

Louisiana State University