OnSite Registration for USNCCM 99, August 4-6, 1999

Name (Last,First,MI) __________________________________________________________

Affiliation: ________________________________________________________________

Mailing address: _____________________________________________________________

City: ___________________________ State: ____________________ Zip: ______________

Country: ____________________

Phone: __(____)________________ Fax: __(____)________________

E-mail: ___________________________________________________________________

Participant _______ X $430 = $__________
Student _______ X $125 = $__________
Extra banquet tickets (by June 15, 1999) _______ X $50 = $__________
Post Conference Short Course, Participant _______ X $120 = $__________
Post Conference Short Course, Student _______ X $60 = $__________
Spouse Program Tickets _______ X $60 = $__________
Total Enclosed   $__________

Special needs (e.g., handicapped, vegetarian) _____________________________

___________________________________________________________

If student, please provide the following information:

Academic institution ________________________________________________________

Department where enrolled ____________________________________________________

Payment Information

Accepted forms of payment:

  • Approved credit card (please fill information below)
  • Check in US currency drawn on US bank, payable to The University of Colorado .
  • Traveller checks.

    Charge Registration and other fees to my credit card:

    Master Card ____ VISA _____ AmEX _____ (Master Card and VISA are preferred)

    Card # ________________________________________ Expiration ___________

    Print name as it appears on card:_______________________________________

    Signature ______________________________________________________________

    Payment must be made prior to or at the time of registration. The University of Colorado cannot accept purchase orders. Cancellation policies and other policies relevant to registration are posted on the conference Web site.