When filling out this form, please note the following:
  • Fields marked with a *red star are required.
  • The conference requires payment in order to attend. There are a number of price options, please pick one of them. You can pay either by credit card or by using another method as indicated below. Please indicate which of these two options you will use.
  • After submitting this page, you will see a summary, including the total price if applicable. You can then either return to the first page to make changes or submit your registration. If you choose to pay by credit card, you will be asked for your credit card information before the registration is finalized.

Personal information

*First name
*Last name
Title
(Mr., Ms, Dr. ...)
What you want to appear on ID Badge
e.g. Jane Doe, Event coordinator
Institution/Company
*Street address
*City
*Province/State
*Country
Postal/Zip Code
*Email
*Phone
Fax
Special requests
(e.g. dietary, accessibility, ...)

Payment method

*Please choose one of the following payment options
Credit Card
Other: If you are planning to submit a cheque instead of a credit card payment, please use the form on the form provided on the website. 

**NOTE: The registration is not complete until payment is received and the spot will not be held until the cheque is received. The complete registrations are processed on first come, first serve basis.**

Please write the cheque to 'Western University'. 

To submit the registration form along with the cheque using the following method and address:

IN PERSON:
Centre for Planetary Science & Exploration
Western Science Center, Room 121
Western University
1151 Richmond St.
London, ON CANADA
N6A 5B7
Phone: (519) 661-2111 ext 88508

BY MAIL OR COURIER: 

Centre for Planetary Science and Exploration(CPSX)
Office of the Dean of the Faculty of Science
Western Science Center, Room 191
Western University
1151 Richmond St.
London, ON CANADA
N6A 5B7

Registration information

*Please choose one of the following price options
Registration Fee ( 75.00 + HST) $84.75
Student Teacher - Special Pricing - Registration Fee ( 40.00 + HST) $45.20