REGISTRATION FORM 2016 MCS SPRING SYMPOSIUM
NAME : AFFILIATION :
PHONE : FAX :
Please indicate if you will register as:
Regular member: $75
Student member: $50
Non-member: $100 (including $25 MCS membership due)
Student non-member: $60 (including $10 MCS membership due)
I wish to register a vendor table(s) for the Symposium at a cost of $500 per table*:
No. of Tables
Please indicate if you will attend the dinner. If you do not attend dinner, there is no refund, but your money will be used to support student participation at the meeting.
I will attend the dinner.
I will not attend the dinner.
Reservations: Must be made prior to 5:00 PM, Friday, April 22, 2015 for guaranteed meals by returning the completed registration form to Vladimir Pushkarev (firstname.lastname@example.org).
Payment: Can be made by mailing a business / personal check or a money order to the following address: Vladimir Pushkarev, Dow Corning Corp., 2200 Salzburg Rd., Mail Stop C043D1, Midland, MI 48686. Payment by cash or check on the day of the symposium is also acceptable. The web version of the registration form, which also includes an electronic payment option via PayPal, is located at www.michcatsoc.org.
*For additional information regarding the vendor participation options please contact Ted Calverley at EMCalverley@dow.com
President: E.M. (Ted) Calverley
Fellow, Core R&D
The Dow Chemical Company
1776 Building, Midland MI,
(989) 636-2881 (phone)
(989) 948-7078 (mobile)
Vice-President: Hongfei Jia
Manager, Materials Research Dept.
Toyota Research Institute of N.A.
1555 Woodridge Ave.
Ann Arbor, MI, 48105
(734) 995-0183 (phone)
(734) 277-1549 (mobile)
Secretary/Treasurer: Vladimir Pushkarev
Catalysis Group/Foundational Research
Dow Corning Corporation
2200 Salzburg Rd., MailStop C043D1
Midland, MI 48686
(412) 266-0074 (phone)