PRINT THIS SCREEN, FILL-IN THE FORM, AND MAIL IT TO THE ADDRESS BELOW

PARI School of Galactic Radio Astronomy Workshop
at the Pisgah Astronomical Research Institute

Registration Form

 NOTE: REGISTRATION DEADLINE is TWO WEEKS BEFORE WORKSHOP

First name  

Last name 

Informal name (for badge)  

Affiliation (for badge)  

Institution (if different from badge affiliation)
  

Address

City  

State

Zip

Country

Phone  

Fax 

Email  

Workshop Date Attending:_________________________________