Fly Ash 2001 Conference/Electronic Attendee Registration Form

International Ash Utilization Symposium
2001 Conference
October 22-24, 2001
Lexington Hyatt Regency
Lexington, Kentucky, USA
Submission Deadline: October 18, 2001

*Secure Electronic Registration Form*
Use ONLY with credit card payment

EXIT FORM & RETURN TO PREVIOUS PAGE

Each block will post as much information as you wish to type.

Registration	includes the following items. Check the event(s) you plan to attend:
	Reception-Monday, October 22, 2001
	Old Kentucky Night-Tuesday, October 23, 2001
	CHECK HERE only if you need VEGETARIAN Meals.

	Prof Dr Mr Ms Mrs Miss
Last/Family Name
First Name	Middle Initial
Name as it should appear on Badge
Company/Organization
Address
City
State
Country
Zip/Postal Code
Phone (include area code)
Fax (include area code)
Email

	Please select category of participation:
	Oral Presentation
	Poster Presentation
	Attendee
	Exhibitor


Registration Fees	Your payment, in full, must accompany this registration form. Check applicable fee:

	$290.00 (USD) Basic fee for 2 or 3 day attendance on or before September 4, 2001
	$375.00 (USD) Basic fee for 2 or 3 day attendance after September 4, 2001
	$145.00 (USD) Basic fee for 1 day attendance on or before September 4, 2001
	$187.00 (USD) Basic fee for 1 day attendence after September 4, 2001

Spouse/Guest Events	Number of Extra Monday Continental Breakfast Tickets - $13.00 each
Spouse/Guest Events	Number of Extra Tuesday Continental Breakfast Tickets - $13.00 each
Spouse/Guest Events	Number of Extra Wednesday Continental Breakfast Tickets - $13.00 each
Spouse/Guest Events	Number of Extra Monday Reception Tickets - $45.00 each
Spouse/Guest Events	Number of Extra "Old Kentucky Night" Tickets - $40.00 each
Name of Guest(s)

Proceedings Volume	If you would prefer your Proceedings Volume in book format INSTEAD of CD format:
	$27.00@ (USD) to help defray the printing cost
	$10.00@ (USD) for UPS ground within the USA or
	$60.00@ (USD) for UPS International Express ouside the USA
CD-ROM Format	Number of Additional Proceedings Volumes in CD Format - $145.00@ (incl shipping & handling)
Book Format	Number of Additional Proceedings Volumes in Book Format - $145.00@ (incl shipping & handling)
Souvenir Bag	Number of Additional souvenir golf bags - $15.00@
	$ (USD) Total amount

Method of Payment	Charge the fee(s) I have indicated above to the following credit card: (American Express and all other cards cannot be accepted.)
	Visa MasterCard
Credit Card #
Expiration Date (month/year)
CardHolder's Name

For any registration queries contact: Geaunita Caylor - Email: (gcaylor@engr.uky.edu) Phone: (859) 257-2820 Fax: (859) 257-2173 Confirmation and receipt will be sent only upon request. You may pickup a receipt at registration.
EXIT FORM & RETURN TO PREVIOUS PAGE
Please contact alice@caer.uky.edu or Phone: 859-257-0308 or Fax: 859-257-0220 if any problems occur with the above form.