| Name | __________________________________ | Profession | __________________ |
| Address | __________________________________ | City | __________________ |
| State/Province | __________________________________ | Zip/Postal Code | __________________ |
| Country | __________________________________ | ||
| Phone | __________________________________ | Fax | __________________ |
| __________________________________ |
CONFERENCE COSTS:
Please list separately each program you are registering for. Be careful you do not register for two programs running concurrently. Note the cost of each program in the right hand column. If there are two prices for a particular program, please choose the one applicable to you. Total the cost of all programs.
Program Cost
| 1. _____________________________________________________ $ ____________ |
| 2. _____________________________________________________ ____________ |
| 3. _____________________________________________________ ____________ |
| 4. _____________________________________________________ ____________ |
| 5. _____________________________________________________ ____________ |
| 6. _____________________________________________________ ____________ |
| 7. _____________________________________________________ ____________ |
| 8. _____________________________________________________ ____________ |
| 9. _____________________________________________________ ____________ |
| 10. ____________________________________________________ ____________ |
| 11. ____________________________________________________ ____________ |
| 12. ____________________________________________________ ____________ |
TOTAL COST: $ ____________
Please enclose a deposit to hold your registration(s) in the amount of one-half (50%) of the total Conference Costs above. DEPOSIT: $ ____________
The balance due must be received at the University by June 6, 2002.
Registration must be accompanied by payment: Check # ____________ Amount: ___________________
Credit Card: ___ VISA ___ MC Card # __________________________________ Exp. Date: _________
Name on Card: _____________________________ Signature: ___________________________________
Cancellation Policy:
If a particular program is cancelled for any reason you will receive a full refund for that program. You may request and receive a full refund up until May 20, 2002. No refunds will be issued after May 20, 2002.