Eighth SIAM Conference on Discrete Mathematics

Preregistration Form

June 17-20, 1996
The Johns Hopkins University
Baltimore, Maryland

There is a "Submit Registration" button at the bottom of this fill-in form. If you don't see the button, or if any of the check boxes or fill-in blanks do not appear correctly, your Web browsing software is not capable of handling this form. If that is the case, you should register by one of the methods listed in Registration Information.

SIAM will send you confirmation of your electronic registration within 10 working days. If you do not receive confirmation, please contact the SIAM Customer Service Department by telephone at (215) 382-9800 or 800-447-SIAM (toll free, USA only) or by e-mail at sevice@siam.org.


Preregistration deadline: Monday, June 3, 1996.

SIAG/DM* MemberSIAM MemberNon-MemberStudent
Preregistration (before 6/03/96)$180$185$215$40
Registration (after 6/03/96)$210$215$245$40
Harbor Dinner Cruise$38 $38 $38 $38

*SIAM Activity Group on Discrete Mathematics.

Registration fees include:

Option and Rate Selection

I fall into this category: SIAG/DM Member SIAM Member Non-member Student

Please register me for the following:

Conference
Harbor Dinner Cruise

Based on the registration fees chart above and the options I chose, my registration fee should be dollars.

Name, Address, and Phone Information

Name:
Organization:
Department:
Business Address:
City: State: Zip:
Telephone: E-mail:
Fax:
Home Address:
City: State: Zip:

Please send all SIAM correspondence to the following address:
Home Business

Please update my SIAM records to reflect the above:
Yes No

Are you a disabled participant that requires appropriate accommodations?
Yes No

Name Badge Information:

NAME BADGE - I prefer my name and affliation to read as follows:
Name (20 characters): Affliation (20 characters):

Payment Information:

I wish to pay by: AMEX VISA Master Card
Credit Card Number: Expiration Date:

Preregistration Form and payment must be received at the SIAM office by June 3, 1996.

Now, to submit your registration form to SIAM, press this button:


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MEM, 4/15/96