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- - - - - - - - - - - - - - - - - - - - - - - - - submit with your check - - - - - - - - - - - - - - - - - - - - - - - - -

              Mail-In Registration Form for PTG Meeting on May 1, 2008

Name _________________________________  Affiliation ______________________________

Address ________________________________  City ______________________  Zip ________

E-mail ___________________________________________    Phone ______________________

__ ACS Member $40;    __ Non-member $50;    __ Student $25.   Must be in by April 17, 2008.

After April 17, 2008:     __ Member $45;     __ Non-member $55;     __ Student $30

__ I will submit a poster:  Title  ____________________________________________________

Send with check payable to “NJACS-Polymer Group” to
Dr. Willis B. Hammond, Treasurer, NJACS-PTG, 128 Center Ave, Chatham, NJ 07928