Your E-Mail Address:

Confirm Your E-Mail Address:

Your First Name:

Your Last Name:

Company/University/College
(if applicable):

Your Address:

Your City:

Your County:

Your State:

Your Zip:

Your Country:

Your Home Phone:

Your Work Phone:

Your Fax Phone:

Your Cell Phone:

Indicate in the boxes below the number of individuals you are registering in each category.

Badges

Provide names (and home town, if different than above) for each person being registered and/or accompanying the Registrant to the Banquet and/or Speaker.

Also, after each name, indicate what is being requested for that individual: Reg (Registration), Stu (Student Registration), B/S (Banquet and Speaker), S (Speaker Only). For Non-Member fees, put N/M in front of the item requested (N/M Reg, for Registration, etc.). Please separate the data for each person with a semicolon. If the individual is a newcomer (or a relative newcomer) to the TAS Annual Meeting, please indicate this by including - N after the other badge information.

Additional Comments about my/our registration:

Meal Choices: (number of each wanted)

Saturday lunch (included in registration)

Banquet

Tours:

Optional Excursions: (number attending; all are free, but space is limited!) Free!

Number of People:

  Friday 1:00 PM - Fort Worth Museum of Science and History

Total Amount: $

Online Registration is no longer available!