Registration Form to Print

Registration Page

Name:__________________________________________________________

Position or Title:__________________________________________________

Institution:______________________________________________________

Address:________________________________________________________

Phone:________________________________e-mail: ____________________________

 

Workshop Registration:

Modeling                         ($5)                                        ______

Dark Matter                        ($15)                                    ______

Cool  Astronomy            ($5)                                    ______

Conference Registration: $40                        ______

Friday Night Banquet: $40                                ______

Total                                                                        ______

Subtract $10 if you are a lifetime member of NES-AAPT Checks should be made out to Thayer Academy

 

Alternatively, you may call in your credit card number to Thayer Academy.

Call Don Donovan at 781-664-2216   Please mail registration form and checks should be mailed to:

Don Donovan

Head, Science Department
Thayer Academy
745 Washington St.
Braintree, MA 02184

Forms must be received by April 20th


To pay by Credit Card:

Type of Card:_________________________________

Account #____________________________________

Name on Card_______________________________

Exp Date_____________________________________

Security Code_________________________________

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