35th Annual Actinide Separations Conference Registration

Thank you for your interest in the 35th Annual Actinide Separations Conference. Please fill out the
form below, all fields (except comments) are required. The information you provide will be used to
create your attendee name badge.

Payment Method: (If you have questions regarding registration, please e-mail Rosalind Blocker or
call her at or (803)725-7745.

Make check payable to: SRNS Actinide Conference and mail to:

Savannah River Nuclear Solutions
NW 6124 PO Box 1450
Minneapolis, MN 55485-6124
(Please include a copy of your registration form.)

Government and Government Contractor employees, please be aware that any meals provided to conference attendees should be disclosed and deducted from per diem amounts claimed on travel vouchers.

First Name :
Last Name :
Attending Type:
Payment :
Guests :

US Citizen :
Affiliation / Company:
Professional Title:
Email Address:
Street Address:
City:
State:
Postal Code/Zip:
Country:
Daytime Phone:
(including area code)
Fax:
(including area code)
Comments:
Total Cost: $300.00
All registration costs must be paid by check or cash only. Credit cards will not be accepted for registration payment.