Preregistration Form

Fifth SIAM Conference on Applications of Dynamical Systems

May 23-27, 1999,
Snowbird Ski & Summer Resort, Snowbird, Utah

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 at (215) 386-7999. If paying by check, please make checks payable to SIAM and mail it with this filled-in order form to SIAM, 3600 University City Science Center, Philadelphia, PA 19104-2688.

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.

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." If you do not see this pop-up message, please contact [email protected] for assistance.

To take advantage of preregistration rates, both Preregistration Form and payment must be received at the SIAM office by Monday May 3, 1999.

Please select only one of the registration fees below

Preregistration deadline - Monday May 3, 1999

SIAG/DS Member*

SIAM Member

Non-Member

Student

Preregistration (before 5/3/99)

$155

$160

$220

$45

Registration (after 5/3/99)

$195

210

$270

$45

* SIAM Activity Group on Dynamical Systems

Box Lunches

Sunday - Wednesday

Sunday, May 23

Monday, May 24

Tuesday, May 25

Wednesday, May 26

Box Lunches

$10

$10

$10

$10

To confirm, please type in the dollar amount of the registration rate you selected above including your box lunch choices. My registration fee is dollars.

Contact Information

Name:

Organization:

Department:

Business Address:

City:

State:

Zip:

Country:

Telephone:

 E-mail:

Fax:

Home Address:

City:

State:

Zip:

Country:

Send all SIAM Correspondence to:

Home Address

Business Address

Update my SIAM records to reflect the above:

Yes

No

Are you disabled and require appropriate accommodations?

Yes

No

Cancellation Policy

Cancellation prior to

May 3, 1999

Full Refund

May 4-14, 1999

$50.00 Cancellation Fee

After May 14, 1999

No Refund

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 phone: (215) 382-9800, fax: (215) 386-7999, e-mail: [email protected], 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):

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


Maintained by Maryann M. Donaghy, [email protected]
Created: 1/20/99 Updated: 2/5/99