UTAH ACADEMY OF SCIENCES, ARTS & LETTERS
MEMBERSHIP, CONFERENCE, & EXCURSION REGISTRATION FORM


Department:  (other institution)

Please check the appropriate membership/registration payment:
$30 -- Membership/Conference Registration (includes luncheon and copy of journal)
$35 -- Joint Membership (2 in same household, one copy of journal)
$20 -- Special Student Membership/Conference Registration (includes luncheon and copy of journal)
$300 -- Lifetime Membership
$10 -- I am a Lifetime Member, Conference Luncheon Only
Planning to attend 2010 Annual Conference?  Yes     No

I will be presenting in the following Academy Division (select one): 

Attending Luncheon: 

Vegetarian

NOTE: While conference attendees may join and register at the door, lunch is guaranteed only for those whose conference registration has been received by March 10, 2010.

I will be attending the 14th Annual Utah Academy Excursion (more info will be available soon): 



Last Updated 11 November 2010
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