BENEFICIATION OF PHOSPHATES
III (1-AP)
December 2-7, 2001
St. Pete Beach, Florida
Name: ____________________________________________________Payment Enclosed_______
Mr.___ Ms.___ Dr.___ Prof.___
Nickname for Badge: _______________________Title_________________________________
Organization: ___________________________________________________________________
Mailing Address: ________________________________________________________________
_________________________________________________________ Country: ______________
City State/Prov Postal Code
Phone: ____________________ Fax: ____________________ E-mail_____________________
ARRIVAL DATE: ______________________ DEPARTURE DATE: ___________________________
Single Room ___ Share Room ___ with Participant ___ Guest ___ Children ___
SIGNATURE: ________________________________________________Date:_________________
Name of Guests: _________________________________________________________________
Names and Ages of Children: _____________________________________________________
Special Needs: __________________________________________________________________
_____ Wheelchair Accessible _____Vegetarian Meals
Please check if member of ____ASCE ____ASME ____AIChE ____AIME ____IEEE
Reciprocating Society (enter name): _____________________________