2000 SIAM Annual Meeting

Preregistration Form - 2000 SIAM Annual Meeting

SIAM is pleased to offer secure ordering. If you are uncomfortable sending credit card information over the Internet via a secure socket connection, please refer to How to Order SIAM Products for alternative payment methods.

To ensure that your registration is processed correctly, please consider the following:

  • Fill-in the form accurately
  • Indicate the events you will be attending to give SIAM an accurate count for meal and reception quarantees
  • Include your credit card number and expiration date
  • Registrations received without payment will not be processed
  • Remember to push the submit button when you're finished!
  • A pop-up message will 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.

Personal Information

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

Select the Appropriate Registration Fee

Short Course on Model Reduction (Immediately prior to Annual Meeting, Sunday, July 9)
Preregistration (before/on June 7, 2000)
On-site ( after June 7, 2000)
Annual Meeting (Immediately after the Short Course, Monday, July 10 to Friday, July 14)
Preregistration (before/on June 7, 2000) $125 Spouse/Guest* # of Guests
On-site (after June 7, 2000) $150 Spouse/Guest* # of Guests

Spouse/Guest Information

Guest #1
Name:
Nickname (for badge)
Guest #2
Name:
Nickname (for badge)
Guest #3
Name:
Nickname (for badge)

If more than 3 guests, please indicate names:

* Children 10 years old or younger do not have to pay guest registration fee. However, please indicate name and age of each child

Select the Get-Together Events You Will be Attending

The events below are complimentary unless a fee is indicated. Please indicate the events you will be attending to give SIAM an accurate count for meal and reception quarantees. Events are categorized by day so please review carefully. See registration information for the details on each event.

Sunday, July 9
Welcoming Reception # of people attending
Monday, July 10
Breakfast # of people attending
Lunch # of people attending
Industry Attendees Reception # of people attending
Student Attendees Beer Party # of people attending
Bus Service to and from Old San Juan # of people attending
Tuesday, July 11
Town/Business Meeting Breakfast # of people attending
Lunch # of people attending
SIAM Activity Group on Imaging Science Meeting # of people attending

Poster Selection:

# of people attending

Teachers' Workshop

# of people attending
Need Parking Pass $14.00
Wednesday, July 12
Breakfast # of people attending
Award Lunch # of people attending
I.E. Block Community Reception # of people attending
Thursday, July 13
Breakfast # of people attending
Lunch # of people attending
Bus Service to and from Old San Juan # of people attending
Friday, July 14
Breakfast # of people attending
Lunch # of people attending

My total payment for the registration fee(s) I selected above including fees for spouse/guests, poster reception, and teachers' workshop parking pass is

Send all SIAM Correspondence to following address: Home Business
Update my SIAM records to reflect the above: Yes No
Are you disabled and require appropriate accommodations? Yes No

Handicap Symbol 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 by fax: (215) 386-7999 or e-mail: lyons@siam.org.

Name Badge Information:

I prefer my name and affiliation to read as follows:

Name (20 Characters):

Affiliation (20 characters):

Payment Information: 

I wish to pay by:

American Express Visa Master Card
Credit Card Number:

Expiration Date:

Please submit this information to SIAM

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