Preregistration Form

Sixth SIAM Conference on Geometric Design

November 2-5, 1999
Sheraton Old Town Hotel,
Albuquerque, New Mexico

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 consider the following:

Fill-in the form as accurately as possible
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.

Preregistration Deadine: Monday, October 11, 1999

Please Select the Appropriate Registration Fee

Preregistration deadline - Monday, October 11, 1999

Conference 11/2-11/5

SIAG/GD Member*

SIAM Member

Non-Member

Student

Preregistration (before 10/11)

$185

$190

$250

$40

Registration (after 10/11)

$235

240

$300

$40

Los Amigos Roundup, Nov. 4

$37

$37

$37

$37

SIAM Short Course on Applications of Classical Geometry in Computer-Aided Design
Saturday, November 6, 1999 (immediately after the conference)

SIAG/GD Member*

SIAM Member

Non-Member

Student

Preregistration (before 10/11)

$150

$150

$195

$75

Registration (after 10/11)

$195

$195

$240

$75

*SIAM Activity Group on Geometric Design

To confirm, please type in the dollar amount of the registration fee(s) you selected above including the Los Amigos Roundup, Nov. 4. My total payment 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

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 and 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

Credit Card Number:

Expiration Date:

Please submit this information to SIAM

Created MMD, 2/17/99; Last Updated MMD, 9/2/99

Conference 11/2-11/5	SIAG/GD Member*	SIAM Member	Non-Member	Student
Preregistration (before 10/11)	$185	$190	$250	$40
Registration (after 10/11)	$235	240	$300	$40
Los Amigos Roundup, Nov. 4	$37	$37	$37	$37