Name:
_________________________________________________


Address:
_________________________________________________

_________________________________________________

_________________________________________________


Telephone/email:
______________________/__________________________


I plan to present at the Poster Session. My tentative title is:

__________________________________________________________________________


I plan to present at the Snapshots of Epikarst session. Geographical information is:

__________________________________________________________________________


I am interested in being picked up at Dulles International Airport:______



Hotel rooms are to be booked directly through the Clarion Inn at 1-800-876-7000. Mention the KWI Epikarst Meeting to receive the meeting rate of $84 per night.

Print this form, complete, and mail together with a check for $280 ($180 for students with proof of student status) to: