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Registration Form
Complete the form and fax to (203) 454-3241 or mail with
enclosed check to:
NASA Conferences Coordination Office,
251 Riverside Avenue,
Westport, CT 06880.
Checks are payable to NASA Conferences.

Name______________________________________________

Position/Title ________________________________________

Organization ________________________________________

Address____________________________________________

__________________________________________________

City, ______________________________________________

State, __________ Zip ______________________

Phone______________________Fax_____________________

E-mail _____________________________________________

plan to attend: ___Mentor-Protégé Conference (MPC) only - $ 95

..........................___NASA Tech. & Business Conference only -$ 95

..........................___MPC & NASA Tech. & Business Conference $175

.___Exhibit Fee, August 11, (inc.1 Registration to Tech & Bus. Conf) $750

Enclosed is a check for $___________

Please charge my credit card: ___M/C ___VISA ___AMEX

#___________________________________Exp. date __________

Name on Card__________________________________________
Registration Deadline: August 3, 1999

PLEASE NOTE: Registrations made after this deadline subject to availability. Refunds will be made
in full if written cancellation is postmarked on or before July 27, 1999.
After this date all registrants will be considered attendees and charged as such.
Substitutions are accepted.

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