REGISTRATION FORM

1) Please tell us about yourself

First Name		Last Name
Organization		Address
Address		Address
City		State
Zip		Phone
Fax		E-mail

2) Tours

I would like to tour:

Ohio SHRP Test Road on Monday

Accelerated Pavement Loading Facility in Lancaster on Tuesday

3) Presentation Information

The information requested for SPS-1 and SPS-2 installations is attached (if applicable)

Please Provide these materials on or before September 1,1999

YES NO (will forward later) Not Applicable

4) Exhibits

I am interested in reserving exhibit space: YES NO

Exibit space is free to govermental agencies. Cost is $100 per 8 ft. x 10 ft. space for non-govermental agencies.

5) Registration fees

Registration: $125 on or before October 1, 1999; $175 after October 1, 1999

Exhibit: $100 on or before October 1, 1999; $200 after October 1, 1999

Registration includes 2 breakfasts, 2 lunches, and 4 breaks and a copy of the conference proceedings

6) Method of Payment

Personal Check (make checks payable to Ohio University)

Goverment Purchase Order

Please mail payment to

Charge Card (Visa or Mastercard)

For security reasons please call (740) 593-2476 or Fax (740) 593-0625 with your payment information