The Society of Rheology 71st Annual Meeting
October 17 - 21, 1999  —  Madison, Wisconsin

Annual Meeting Registration Form
    
Please print form, then neatly print appropriate information, and fax or mail to: Rheology 71st Annual Meeting, Attn: Pat Gaitan, The Pyle Center, 702 Langdon Street, Madison, WI 53706-1487. Fax: (608) 265-3163
 Name:
  Badge Name:
Affiliation:
 Address:
 City, State:
  Zip, Country:
Telephone:
 Fax:
  E-mail:
Registration Fee: Conference registration includes program as well as access to the vendor display, all technical sessions, Monday Business Lunch, coffee breaks and receptions. The registration fee does not include the Banquet, which is subject to limited seating. Please indicate the number of tickets you are purchasing for this event. Cancellations received in writing by September 17, 1999 will be subject to a $25 administrative charge. No refunds will be granted after that date.
Fee (before 9/17/99) Fee (after 9/17/99)
Member $100 $140
Non-Member (includes membership) $140* $190*
Non-Member $140 $190
Student (includes membership) $55* $60*
Student $30 $35
Retired Member $30 $35
Banquet Ticket $35 $40
*Non-Member registration includes an optional 1-year membership in The Society of Rheology. Students can become members for an additional $25. Members receive the Rheology Bulletin, the Journal of Rheology (6 issues) and Physics Today (12 issues).
Method of Payment: Check or money order
         (payable to UW-Extension)		 Mastercard Visa
Cardholder Name:
Account #: Expiration Date:
Signature (required for credit card transaction):
Early registrations will be confirmed with a printed receipt by mail. Late registrations will receive a printed receipt in your conference packet. Forms with credit card information may be faxed to (608) 265-3163. 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		 Any accommodation requirements:
 Dietary requests: