REGISTRATION FORM

7^TH SYMPOSIUM ON MOLECULAR REACTION DYNAMICS

IN CONDENSED MATTER

Hotel Laguna, Laguna Beach, California

March 3 - 6, 2004

ALL CONFERENCE ATTENDEES ARE REQUIRED TO COMPLETE THIS FORM. The following information is necessary for pre-registration, attendee meetings and getting last minute pertinent information to you.

(PLEASE TYPE OR PRINT CLEARLY)

Name____________________________________________________________

                    (First)             (Middle Initial)                      (Last)

Title_____________________________________________________________

College/University/Organization _______________________________________

Department _______________________________________________________

Street Address _____________________________________________________

City ______________________ State______________ Zip code_____________

Phone __________________________ FAX _____________________________

E-Mail Address ____________________________________________________

Conference Registration Fee for ALL attendees is $325. A companion fee for meals only is

$300. Preregistration deadline is Feb. 12, 2004. Please make check/money order payable to

"U.C. Regents". If you are not able to preregister by Feb. 12, 2004, we will accept

payment (check or cash) during conference registration at the Hotel Laguna.

We will not be able to accept credit cards.

PLEASE COMPLETE AND FAX THIS FORM TO: (949) 824-3168 OR mail to:

Erika Metz

University of California, Irvine

516 Rowland Hall

Irvine, CA 92697-2025

Phone:949-824-4560

Fax: 949-824-8571

email: emetz@uci.edu