Dr. Prof. Mr. Ms.                                      Male Female     

       Position                                              Institute | University | Organization

      Mailing Address

       City                                     State                                     Zip Code                          Country

                               Country Code                  Area Code                     Number

       Phone                                                   

       Fax                                                       

       Email               

I. Registration Fee:

(Select one. Each conference participant must register for the conference. The registration fee is not required for your companions. )

            $150 (Regular attendee)                 $75 (Student)                 Invited Speaker

     II. Room and Meals Fee:

This fee includes 3 nights of accommodation and eight meals. See conference schedule for designated meals. Check-in on August 11, 2005 at 4:00 PM and Check-out on August 14, 2005 at 11:00 AM

     A. For individual conferees (If you are bringing companions, make selections in Section B only.)

                  $719 per person (Single room for one registered conferee)                            

                  $482 per person (Double room for two registered conferees) 

              Do you have preferred roommate? If so, indicate name here:   

              Room preference:         Smoking                            Non-smoking

Please indicate any special dietary needs i.e. food allergies, restrictive diets, etc. (Special services will be provided when possible.):      

             Please specify your dinner selection for the Banquet that will be held on August 13, 2005: (Must select one.)

              Prime Rib (Beef)                     Lemon Sole (Fish)               Vegetarian Plate

             B. For conferees with companions:

Complete this section for conferees with companions. Select all options that apply in the following table. Determine the total Room and Meals Fee by summing the costs for all selections you make. 

               Room preference:         Smoking                            Non-smoking

Please indicate any special dietary needs i.e. food allergies, restrictive diets, etc. (Special services will be provided when possible.):      

Please specify your dinner selection for the Banquet that will be held on August 13, 2005: (Please indicate the number of each meal option.)

   III. Workshop on Two-Dimensional Correlation Spectroscopy:

Workshop on Two-Dimensional Correlation Spectroscopy will be held from 8:30 AM to 12:00 PM on August 14,  2005.

  $50 per person for regular attendees and invited speakers

  $0 for students

    IV. Payments

            Total Payment (Add I. Registration Fee, II. Room & Meals Fee and III. Workshop Fee.):      

                                                                                       Total:  

            Payment Methods: (Please select one.)

               Pay by Credit Card (Visa and MasterCard are accepted.) 

Pay by Institutional Check or Money Order (Check or Money Order must be drawn on a U.S. Bank or marked "Pay in U.S. Funds". Make check or money order payable to the University of Iowa)

Pay by Bank Transfer (On receipt of the completed electronic registration form, you will be sent further instructions for the bank transfer.)

When you submit this registration form, a Registration Confirmation page will be displayed. Print the confirmation page and fax or mail it along with the payment to:                                          

                                                                                 Ms. Reygan Freeney

                                                                                 Department of Chemistry/2DCOS-3

                                                                                 University of Iowa

                                                                                 Iowa City, IA 52242

                                                                                 U.S.A.

                                                                                 Phone: 001-319-335-3588

                                                                                 Fax: 001-319-335-1270

Payments must be received by July 8, 2005.

Cancellation request must be received in writing on or before August 2, 2005.  Fees for registration and meals will be fully refunded.