Computational Science Workshop for Louisiana Educators

(secure on-line)

LSU Campus
Baton Rouge, LA USA


First Name: *
Last Name: *
High School/ Affiliation: *
Address: *
City: *
Prov / State: *
Postal Code: *
Telephone: *
E-Mail: *
Subject you Teach: *


I'd like to purchase a parking permit ($15). Provide payment info below.

I'd like to request a laptop to be used during the workshop.

I need vegetarian meals.


Payment Information:(Optional)
Payment Method: Visa
MasterCard
Discover

Credit Card Information

Credit Card Number:
CCV Code:
(3 or 4 digit validation code on back of card)
Expiration Date: /
Name of Card Holder:

Cancellation/Substitution Policy: Cancellations received and post-marked prior to June 30, 2010 will receive a full refund. After June 30, no refunds will be issued. Substitutions will be permitted!