Form to be postmarked by: June 29, 2001    (please print clearly)

Name as it will appear on badge: ______________________________________________

Company:________________________________________________________________

Department:______________________________________________________________

Address:_________________________________________________________________

City,State,Zip:_____________________________________________________________

Phone:_(_____)___________________________Fax_(_____)______________________

Email:___________________________________________________________________

• Step 1 - Select your membership class below and circle your choice:

NAOSMM regular member pre-registration fee (including receptions, all coffee
breaks, and Thursday banquet ticket. Full registrants receive a nametag.............$ 130.00

On-site NAOSMM regular member registration..... ..........................................$ 160.00

Non-member full registration, includes one year membership..............................$ 180.00

Are you a new member, or non-member seeking to join?....................................   Yes

Are you attending the conference for the first time? ............................................    Yes

• Step 2 - Additional fees (optional)

I would like to prepay my 2002 dues ............................................................$   50.00

CEU payment...................................................................................................$     5.00

Laboratory Safety Institute one-day workshop, Saturday, July 28th..................$ 225.00
click here for registration form

Red Cross CPR  & first aid training, Sunday, July 29th......................................$   21.00

• Step 3 -  Select your tour choices, if any, for yourself

Sunday tour of Grand Rapids and Meyer May………...……....………………$   20.00

Friday tour of the VanAndel Institute for Cancer Research…………………….$   15.00

Friday trip to Saugatuck………..……………………………………………..$   45.00

(see Companion Registration form for description)

Select registration level and tour choices for companions here.

• Step 4 - Add up your selections

  
  Total $ enclosed............................................................................_____________

• Step 5- To enable us to track our room block better, please

  
  indicate how many nights you will be staying at the hotel.  Thanks.  _____________

• Step 6 - Use your browser to print out this form. Complete and return with your check PAYABLE TO NAOSMM or provide MC/V/AMEX information filled in. Then mail to address below:

Jeffrey A. Your
Department of Chemistry
John Carroll University
20700 North Park Blvd.
University Hts OH 44118

Or fax  to Jeff: (216) 397-1791

CC#_______ _______ _______ _______

Expiration date:______/_______

Zip Code where Card is registered_____________________

Authorized Signature Here____________________________

To receive the preregistration discount:   Form must be postmarked by June 29, 2001

• Step 7 - Make your reservations  - Be sure to tell them you are with NAOSMM.

SITE INFORMATION

Amway Grand Plaza Hotel
187 Monroe Avenue
Grand Rapids MI 49503

Cost: $106/day, single or double, +12% tax

Toll Free Reservations Phone: 800-253-3590
Fax:  616-776-6489

Each person registering is responsible for arranging his/her accommodations. To receive the above room rate, contact the hotel directly. Be sure to tell them you are with NAOSMM.     Reservations must be made NO LATER THAN June 29, 2001.