Registration Form - Commercialization of PEM Fuel Cells

Registration Form

GlobalTech 2004 The Hydrogen Economy Becoming Self-Sufficient in Energy Thursday, April 15, 2004
.
The Hydrogen Economy, Farmingdale State, April 15, 2004 Registration -if received: March 1 - April 2: $75 April 3-12: $85 At door: $90	Make checks payable to “ASC - GlobalTech” and send with this form to: Dr. Paul Kramer Physics Department Farmingdale State University of New York 2350 Broadhollow Rd. Farmingdale, NY 11735-1021. Receipt of your registration will be acknowledged by e-mail. Refund Policy: Until April 9, 100%; April 10 and later, no refunds.

Name
Title
Company/Organization
Address
Address
City State Zip	___ I am a student, or member of the faculty or staff at Farmingdale State. I request a President’s scholarship of $55. The remainder of the registration fee is enclosed.
Phone
E-mail