DEADLINE FOR RECEIPT OF ADVANCE REGISTRATION IS SEPTEMBER 15, 1999
Pacific Conference / 35th ACS Western Regional Meeting
Ontario Convention Center, CA, October 6-8, 1999
o Dr. oMr. oMs oMrs.          Name for Badge ___________________________________________________
Professional Affiliation _______________   Local Section ______________________________________________
Street Address ________________________________________________________________________________
City, State Zip _________________________________________________________________________________
Telephone (office), (home)_________________   Fax ____________Email _________________________
o Please check here if you have a disability and require special services. We will contact you prior to the meeting.
o Please check here if you do not wish to have your name and address included on a list provided to exhibitors.

Registration Fees:                    Member of: oSAS      oACS
Type of Affiliation ADVANCE   ON-SITE
o 1. Academe o 01. ACS/SAS Member $75 o11. ACS/SAS Member $100
o 2. Industry o 02. Non-member $90 o 12. Non-member $115
o 3. Government o 03. Post Doc $75 o 13. Post Doc. $100
o 4. Student o 04. Graduate Student  $50  o 14. Graduate Student $75
o 5. Other  o 05. Undergrad. Student $20 o 15. Undergrad. Student  $25
o 06. Precollege Teacher  $20 o 16. Precollege Teacher $25
o 07. Retired/Emeritus $35 o 17. Retired/Emeritus  $50
o 08. 50 Year ACS Member no charge  o 18. 50 Year ACS Member no charge
o 09. Unemployed ACS Member  no charge  o 19. Unemployed ACS Member  no charge
o 10. Nonchemist Guest/Spouse $35 o 20. Nonchemist Guest/Spouse  $50
                   Note: Presenters must register for the meeting
 
Special Events(Please specify # of participants/tickets)  Workshops 
o 01. Women Chemists Lunch, Oct. 6 $25 X____ = $______     o 06. Capillary GC I, Oct. 7 $30
o 02. Minority Affairs Lunch, Oct. 7 $25 X ___ = $______    o 07. Capillary GC II, Oct. 7 $30
o 03. SGS 50th Anniv. Dinner & HS Teacher Award, Oct. 7  $45 X ___ = $______    o 08. FTIR Sampling, Oct. 6 $30
o 04. Undergrad. Student Lunch, Oct. 8 $10 X ___ = $______    o 09. Equipment Validation, Oct. 7  $50
o 10. ISO 14000, Oct 8 $150
Tours sign up—No charge o 11. Project Inclusion, Oct. 8 no charge
o 12. Sunkist Growers Research Center, Oct. 7 o 15. Kids & Chemistry, Oct. 8 no charge
o 13. Graber Olive House, Oct. 8
o 14. Beckman-Coulter Heritage Center, Oct. 8

NOTE: Request for refunds must be submitted to Tracey Nguyen in writing.  Full Refund until September 1. From September 1 to October 6, $20 processing fees will be charged. No refunds after October 6.
 TOTAL FEES:  Registration $___________________     Special Events $_________________     Workshops $____________________
TOTAL AMOUNT ENCLOSED $__________________      Paid by: oCheck oVisa oMaster Card oAmerican Express
Credit Card Account No.______________________________________ Credit Card Expiration Date________________________
Cardholder Signature
                                           ________________________________________
MAIL COMPLETED FORM TO: TRACEY NGUYEN, AMERICAN CHEMICAL SOCIETY, OFFICE OF REGIONAL MEETINGS,
1155 16TH STREET, NW, WASHINGTON, DC 20036 OR FAX TO: 202/776-8299 OR 202/872-6128
Make check payable to: American Chemical Society. Please submit a separate form for each registrant.

This registration form is also available in PDF format at: http://www.acs.org/meetings/wermreg99.pdf