SODA'98 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 bottom 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 donaghy@siam.org for assistance.

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

Registration Fees

Preregistration Deadline: Monday, January 12, 1998

Conference January 25-27, 1998
ACM-SIAM MemberNon-Member Student
Preregistration (Prior to Jan. 12) $310$360$75
Registration (After Jan. 12) $360$410$125

Option and Rate Selection

I fall into this category:
ACM-SIAM Member
Non-Member
Student

Based on the registration fees chart 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 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 affliation 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 Monday, January 12, 1998.

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MMD, 1/5/98