Preregistration Form (Mandatory Fields = *)

Preregistration deadline: Thursday, May 15, 2003

It is SIAM policy that all speakers pre-register. Speakers who do not pre-register will be required to register on-site at the higher rate.

Note: A passport is *highly recommended* for U.S. visitors entering Canada. U.S. citizens should have their birth certificate or citizenship certificate as well as a picture ID; permanent residents (who are not citizens) need their alien-registration card and passport. Citizens from all countries other than the U.S. must have a valid passport, and in some cases a visitor visa may be required.

SIAM is pleased to offer secure ordering. If you are uncomfortable sending credit card information over the Internet via a secure socket connection, please print this order form, fill it out, and fax it to SIAM at (215) 386-7999. If paying by check, please make your check payable to SIAM and mail it with this filled-in form to SIAM, 3600 University City Science Center, Philadelphia, PA 19104-2688. For more information on alternative payment methods, please refer to How to Order SIAM Products.

AN E-MAIL CONFIRMATION WILL BE SENT TO YOU WITHIN 10-15 WORKING DAYS. If you do not receive it, SIAM has not processed your registration. Please contact meetings@siam.org if you do not receive an e-mail confirmation by May 29, 2003. Your printed receipt will be included in your registration packet on-site.

To ensure that your registration is processed correctly, please fill in the following form as accurately as possible. Make sure you 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 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." This is not your registration confirmation. If you do not see this pop-up message, please contact hannan@siam.org for assistance.

All advance registration payments are to be made by credit card, check, or money order. All fees quoted are in U.S. dollars. To take advantage of preregistration rates, a $60.00 savings, both Preregistration Form and payment must be received at the SIAM office by Thursday, May 15, 2003.

Personal Information

*First Name:
*Family (last) Name:

*Male or Female:
(For Statistical Purposes only)

*Speaker Information:
*Organization Name:
*Organization Type:
Department:
*Address:
*City:
State:
*Zip:
*Country:
*E-mail:
Telephone:
Fax:

Student Verification

In order to qualify for the Student Rate, students must list the name, affiliation, and e-mail address of one professor who can verify your student status.

I am a
Professor Name:
Affiliation:
Professor E-mail:

**Student registrants will receive a “Student” badge on-site.**

Please select only one of the registration fees below

Preregistration Deadline: Thursday, May 15, 2003.

All advance registration payments are to be made by credit card, check, or money order. All fees quoted are in U.S. dollars.

Minisymposium organizers and speakers will also be required to register at the SIAM ON-SITE member rate if they do not preregister.

AN03 Conference Registration - June 16-20, 2003
Select CAIMS/SIAM Conference registration fee:
*
**Student registrants will receive a “Student” badge on-site.**

Please select the Get-Together events that you will be attending

To avoid wasteful preparation of food, we appreciate your help in letting us know which meal functions you will attend. All events are included in your registration fee unless you wish to bring a guest to the Awards Luncheon. All events, regardless of fee, require your name badge for admission. Tickets are required for noted events. All tickets are non-refundable after May 15.

Welcome Reception
Sunday, June 15, 6-8 PM
*
Please indicate if you will have guests
Career Fair and Graduate Student Reception
Monday, June 16, 6-7:30 PM
*
Please indicate if you will have guests
Award Luncheon (this is a ticketed event)
Tuesday, June 17, 12–2 PM
*
Please indicate if you will have guests
There is a fee of $36.00 per person that applies to all guests
Poster Session
Tuesday, June 17, 8-10 PM
*
Please indicate if you will have guests
Community Reception
Wednesday, June 18, 7–9 PM
*
Please indicate if you will have guests
SIAM Business Meeting and Continental Breakfast
Thursday, June 19, 7:30-8:45 AM
*
Please indicate if you will have guests

Conference Registration Fee Includes:

  • Welcome Reception, Sunday, June 15
  • Career Fair and Graduate Student Reception, Monday, June 16
  • Award Luncheon, Tuesday, June 17
  • Poster Session, Tuesday, June 17
  • Community Reception, Wednesday, June 18
  • SIAM Business Meeting and Continental Breakfast, Thursday, June 19
  • Access to e-mail facilities Sunday, June 15 through Thursday, June 19
  • Two coffee breaks daily
  • Admission to all technical sessions
  • Room set-ups and audio-visual equipment

To confirm, please type in the TOTAL dollar amount of the registration rate(s) you selected.
My registration fee is $ dollars.
*

Send all SIAM Correspondence to: Home Business
Update my SIAM records to reflect the above: Yes No
Are you disabled and require 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 Americans with Disabilities Act, or assistance in registering for this conference/meeting, please contact Coley Lyons by phone: (215) 392-9800; fax: (215) 386-7999 e-mail: lyons@siam.org; or mail: Society for Industrial & Applied Mathematics, 3600 University City Science Center, Philadelphia, PA 19104-2688.

Name Badge Information:

I prefer my name and affiliation to read as follows:

Name (20 characters max):

*
Affiliation (30 characters max): *

Payment Information: 

I wish to pay by:

Visa Mastercard * 
Name as it appears on Credit Card: *
Credit Card Number: *

Expiration Date:

*

Please submit this information to SIAM

 

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Created 8/20/02
Edited 3/11/03