PERSONAL INFORMATION: Your Name: (please do not use special accents, i.e. umlauts etc.) First: Last: Affiliation: Mailing Address: Line 1: Line 2: Line 3: Line 4: Line 5: Day Phone: Fax: Email: Committee Preferences Please check all committees, which you'd like to participate in, from the list below: Physical Sciences Geoscience Biological Science Mining & Engineering ES & H Industry Relations Government & Community Broader Impacts Low Counting Facility Management