63^rd Pittsburgh Diffraction Conference Registration

November 3, 2005 through November 5, 2005

Argonne National Laboratory

9700 S. Cass Avenue, Bldg. 360

Argonne, Illinois 60439

Accomodations

A limited block of rooms has been reserved for the conference at the Argonne Guest House under the name

“Pittsburgh Diffraction Conference”

Please make your reservation directly with the Guest House at (630) 739-6000. The rate is $58.30/single and $65.00/double, tax included. The block of rooms will be held until October 21^st, 2005.

Registration

Everyone MUST register! Please FAX or email completed form to Charles H. Lake

lake@iup.edu

Department of Chemistry

Indiana University of Pennsylvania

Indiana, PA 15705

FAX (724) 357-2437

AND remember to send abstracts for posters or talks and nominations for the Sidhu Award to Tom Koetzle

tkoetzle@anl.gov

Argonne National Laboratory, Bldg. 360

9700 S. Cass Avenue

Argonne, IL 60439

For additional information including the conference program and a description of the Sidhu Award, go to http://www.pittdifsoc.org/

Registration Form for the 63^rd PDC

Title and full name (Please print or type):

____________________________________________________________

Preferred name for the meeting badge:

____________________________________________________________

Mailing address (Please indicate if Home [ ] or Work [ ]):

____________________________________________________________

____________________________________________________________

Phone numbers: Work: ___________________________

Home: ___________________________

e-mail: _____________________________________________________

THE FOLLOWING APPLIES TO NON-U.S. CITIZENS ONLY

City of Birth Country of Birth

Date of Birth Male Female

Country of Citizenship Job Title

Legal Permanent Resident (LPR) of the United States (Please Circle One) YES NO

LPR Number__________________________Expiration Date_____________________________

Passport Number

Country of Issue Expiration Date

Visa Number Type of Visa Expiration Date

Please indicate if you are presenting a Poster [ ] or an Invited Talk [ ].

Registration Fee, Dues and Banquet Ticket

[ ] Non-student [waived for invited speakers] …. $75

[ ] Student …………………………………………. $25

[ ] Biennial Membership Dues (required) ……. $10 (if not paid in 2004)

[ ] Banquet Ticket ………………………............. $50

[ ] Grilled Swordfish

[ ] Vegetable Lasagna

[ ] Roasted Chicken

[ ] Grilled Tenderloin

Amounts are in $USD (drawn on a US bank), payable to “The Pittsburgh Diffraction Society.”

You may also mail registration and check to:

Charles H. Lake

Department of Chemistry

Indiana University of Pennsylvania

Indiana, PA 15705