Communicating Astronomy to the Public
Conference
Credit Card Information Form - Visa and Mastercard Only
Print this page and mail to:
Registration for CCAP
c/o Charles Blue
NRAO
520 Edgemont Road
Charlottesville, VA 22903
or FAX to (434) 296-0255
Name of person(s) registering: ___________________________________________________
Name (on card): _____________________________________
Billing Address: ____________________________________________________________________________
Daytime Phone Number: ( )__________________
Card Type (circle one): Visa / Mastercard
Card Number: ______________________________
Expiration Date (mo/yr): _______________
Card Authorization Number
(Mandatory -- the 3 digit number located on the back of the card: ___________
Total Cost for registration: $120.00
For payment for the post-conference trip to Green Bank (cost $25) Check here ________.
Space for bus tour to Green Bank is limited. Confirm with Charles Blue prior to payment.
Cardholder sign here: ___________________________________