CT98 Preregistration Form

SIAM is pleased to offer secure ordering. If you are uncomfortable sending credit card information over the Internet via a secure socket, please print this order form, fill it out, and fax it to SIAM. SIAM's fax number is (215) 386-7999.

To ensure that your registration is processed correctly, please fill-in the following form as accurately as possible. Please make sure you include your credit card number and expiration date. Registrations received without payment will not be processed. Don't forget to push the submit button when you're finished! A pop-up message should appear saying "Thank you for filling in the form. Your response has been received by our server. Thank you for using the SIAM Web Server." If you do not see this pop-up message, please contact [email protected] for assistance.

A written confirmation will be mailed to you within 10-15 working days. If you do not receive it, please contact [email protected]. If the conference has already started, your receipt will be included in your registration packet on-site.

A special membership application form is available for attendees of the Fourth SIAM Conference on Control and Its Applications. Both the registration form and membership form must be completed and submitted to SIAM to take advantage of the discount.

Registration Fees

Conference May 7-9, 1998
	SIAG/CST Member	SIAM Member	Non-Member	Student
Preregistration (Prior to April 23)	$155	$160	$220	$40
Registration (After April 23)	$205	$210	$270	$40

Option and Rate Selection

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

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

Check here if you are joining SIAM to take advantage of the member registration fee. Don't forget to choose the SIAM Member category or the SIAG/CST Member category (if you're joining the Control Activity Group) above!

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 Address Business Address

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

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

SIAM wishes to take steps to ensure that no individual with a disability is excluded, denied services, segregated or otherwise treated differently than other individuals because of the absence of auxiliary aids and services. If you need any auxiliary aids or services identified in the American with Disabilities Act, or assistance in registering for this conference/meeting, please contact Coley Lyons at (215) 382-9800 or write to her at Society for Industrial & Applied Mathematics, 3600 University City Science Center, Philadelphia, PA 19104-2688.

Name Badge Information:

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

Payment Information:

I wish to pay by:

Credit Card Number: Expiration Date:

Please submit this information to SIAM.

To take advantage of preregistration rates, both Preregistration Form and payment must be received at the SIAM office by Thursday, April 23, 1998.

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