Santa Fe 4 Registration Form  

Name: __________________________________________________________

Institution: _______________________________________________________

Address: _________________________________________________________

E-mail: __________________________________________________________

Housing 

    [ ] Single Room ($245). Includes three nights lodging, all meals and coffee breaks, and a campus use fee. $36 will be refunded if no singles are available
    [ ] Double Room ($209). Includes three nights lodging, all meals and coffee breaks, and a campus use fee

    Roommate Preference(s):______________________________________

                                                 ____________________________________ 
    [ ] Off-Campus ($15). Includes campus use fee

TOTAL PAYMENT: $____________ 

    [ ] Check enclosed (US dollars only), payable to the University of Minnesota 

    [ ] Charge to [ Visa / MasterCard / Discover ] (circle one) 

    card #___________________________________ expdate:___________ 

    signature: ________________________________ 

Travel Fellowship Application 
Travel fellowships provide reimbursement of up to $250 against actual incurred travel costs. Awards will be announced by May 20, 1998. 
    [ ] Student      [ ] Post-PhD (check one) 

    Current grants, sources and amounts 
    (used to determine eligibility; if none, write `none'):_______________________________

                                                     _______________________________

    Social Security Number (required for reimbursement to US citizens):__________________

Note for non-US citizens: if you need a visa or a visa waiver to enter the US, make sure that you get a business-class visa (B-2) or waiver (WB), rather than a tourist-class (B-2), or we will NOT be able to process your reimbursement. 

Return this form by May 15, 1998 to: 
Institute for Rock Magnetism 
293 Shepherd Labs 
100 Union Street S.E. 
Minneapolis, MN 55455-0128