DS00 Preregistration Form

Preregistration Form

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

Registration for ALL events is required and admission is by presentation of ticket only

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 [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.

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

Preregistration Deadline: Friday, June 30, 2000

	* SIAG/DS Member	SIAM Member	Non-Member	Student
Preregistration (on or before June 30)	$235	$240	$340	$55
Registration (after June 30)	$295	$300	$400	$55

*SIAM Activity Group on Dynamical Systems

Select the Get-Together Events You Will be Attending

Registration for ALL events is required and admission is by presentation of ticket only. The events below are complimentary unless a fee is indicated. All events regardless of fee require a ticket so you must register for all events you wish to attend. Events are categorized by day so please review carefully. See registration information for the details on each event.

Tuesday, August 8

Welcoming Reception

# of people attending

Thursday, August 10,

Special Event - 2000 Marriott Luau (tickets will be issued!)

$63.00 per adult
$25.50 per child

# of adults attending
# of children attending

Names of adults:
Names of children:

Friday, August 11

$12.00 Poster/Dessert Reception

# of people attending

Poster Only - No Reception

# of people attending

My total payment for the registration fee(s) I selected above including fees for the special event and poster reception is

Send all SIAM Correspondence to following address:

Home

Business

Update my SIAM records to reflect the above:

Yes

Are you disabled and require appropriate accommodations?

Yes

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: [email protected].