Title* Dr. Mr. Mrs. Ms. First Name* Last Name* Company / School* Department Mailing Address* Suite, Apt, Room, Floor, etc. City* State or Providence — – UNITED STATES – Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming – CANADA – Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory – AUSTRALIA – Australian Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia Country* — United States of America Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua & Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire Bosnia & Herzegovina Botswana Brazil British Indian Ocean Ter Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Canary Islands Cape Verde Cayman Islands Central African Republic Chad Channel Islands Chile China Christmas Island Cocos Island Colombia Comoros Congo Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Ter Gabon Gambia Georgia Germany Ghana Gibraltar Great Britain Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guyana Haiti Hawaii Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea North Korea South Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malaysia Malawi Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Midway Islands Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Nambia Nauru Nepal Netherland Antilles Netherlands Nevis New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Norway Oman Pakistan Palau Island Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Island Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda St Barthelemy St Eustatius St Helena St Kitts-Nevis St Lucia St Maarten St Pierre & Miquelon St Vincent & Grenadines Saipan Samoa Samoa American San Marino Sao Tome & Principe Saudi Arabia Senegal Seychelles Serbia & Montenegro Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Tahiti Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad & Tobago Tunisia Turkey Turkmenistan Turks & Caicos Is Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City State Venezuela Vietnam Virgin Islands (Brit) Virgin Islands (USA) Wake Island Wallis & Futana Is Yemen Zaire Zambia Zimbabwe Zip or Postal Code* Email Address (Enter your email if you would also like to receive monthly conference updates.) Mobile Phone (Enter your phone number if you would also like to recieve mobile alerts.) Please indicate what type of information you wish to recieve* Attending Pittcon Exhibiting Pittcon Please tell us what prompted you to visit the Pittconn website today* — Ad in publication Article Brochure Colleague referral Direct mail piece E-mail piece Press release Internet search engine Trade show/professional meeting Vendor/publisher website Other (other) Type of Industry* — Aerospace Agriculture Analytical Chemistry/Equipment/Instruments Biotechnology/Biochem Chemicals/Chemical Equipment Contract Laboratory Cosmetics/Fragrances/Flavors Distributor/Import/Export Education Electronics/Computer/Semiconductor Energy/Power Environmental/Air/Water/Wastewater Food/Beverage/Consumer Products Instrument Manufacturing Lab furniture/Accessories/Equip/Instruments Laboratories/Research/Testing/Government Agency Life Science/Bio Manufacturing Medical/Clinical/Forensics Metals/Materials/Minerals Other Petroleum/Petrochemicals Pharmaceutical Polymers/Coatings/Rubber Sales Transportation Scientific Specialty* (You may select multiple specialties by using Command key on a Mac or Control on a Windows machine) Chromatography – Gas Chromatography – Ion Chromatography – Liquid Chromatography – Other Electrochemistry Electrophoresis Lab Automation LIMS Microscopy Other Particle Analysis Physical Measurements Process Control/Monitoring Sequencing Spectroscopy – AA/Emission Spectroscopy – ICP Spectroscopy – IR/Raman Spectroscopy – Magn Res Spectroscopy – Mass Spectroscopy – Other Spectroscopy – X-ray Spectroscopy UV/Vis Surface Analysis Thermal Analysis Please enter the following into the box for verification: