Inspiration of Astronomical Phenomenon Conference
Registration Form

Note: If you are a conference presenter, you only have to fill in your name; we have your contact information on file.
 
NAME:
_____	_____	_____	_____
Title		First Name		Middle Name/Initial		Last Name

INSTITUTION:
_____
Name of Institution

ADDRESS:
_____
_____
Street Address
_____	_____	_____
City				State/Province			Postal Code
_____	_____
Country 							Email
_____	_____
Telephone							Fax

PRE-CONFERENCE TRIP (space is limited)
$200




Conference Registration - Full Week, June 26 - July 1
$475

Conference Registration - Sunday, June 26
$125

Conference Registration - Monday, June 27
$125

Conference Registration - Tuesday, June 28
$125

Conference Registration - Wednesday, June 29
$125

Conference Registration - Thursday, June 30
$125

Conference Registration - Friday, July 1
$125

TOTAL REGISTRATION





Conference Housing - Full Week, June 26-July 1 (check out July 2)
$450

Conference Housing - Number of nights: _________
Check-in date: _____________
Check-out date: ____________
$75 per night




TOTAL HOUSING





TOTAL REGISTRATION AND HOUSING DUE



Make checks payable in US Dollars to ADLER PLANETARIUM.  

Mail to:  INSAP V - Jodi Lacy, Adler Planetarium & Astronomy Museum, 1300 South Lake Shore Drive, Chicago, IL 60605