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.
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
if you do not receive an e-mail confirmation by May 7, 2003.
Your printed receipt will be included in your registration packet on-site.
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 firstname.lastname@example.org
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, both Preregistration Form and payment must be received at the SIAM
office by Wednesday, April 23, 2003.
(For Statistical Purposes only)
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
I am a
**Student registrants will receive a Student badge on-site.**
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.
Conference Registration Fee Includes:
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:
email@example.com; or mail: Society for Industrial &
Applied Mathematics, 3600 University City Science Center, Philadelphia,
(20 Characters): *
I wish to pay