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221 Witherspoon St, 2nd fl
Princeton, NJ 08542-3215
Email: nasonweb@nas.org
Tel 609-683-7878

CONFERENCE REGISTRATION FORM

First Name:

Middle Name:

Last Name:

Member Status:

Member ($125)
Graduate Student ($40)
Non-Member ($150)

Affiliation:

Field of Studies:

Address:

City:

State:

Zip Code:

Phone Number:

(999-999-9999)

E-mail Address:

If primary registrant is an NAS member, his guest(s) will cost $125 each. If primary registrant is not an NAS member, his guest(s) will cost $150 each.
	Name	Affiliation
Guest 1
Guest 2

Donation:

I would like to make a tax-deductible contribution in the stated amount to support the ongoing work of the NAS.

Membership:

I wish to join (or renew my membership in) the NAS, receive a subscription to Academic Questions, and qualify for the member's conference rate.
Dues are:
$22 for graduate students and adjunct and emeritus faculty
$42 for full-time faculty and administrators