SIAM/MAA BBQ Preregistration Form

Thursday, July 16, Medical Science Building Lawn
6:30 PM-8:30 PM, $20.00 U.S.
Advance registration necessary.

For additional information, see SIAM "BBQ/Canadian Style" in registration information.

The Preregistration Form must be received at the SIAM office by June 23, 1998.

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.

To ensure that your registration is processed correctly, please fill-in the following form as accurately as possible. Please 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.

An e-mail confirmation will be sent to you within 10-15 working days. If you do not receive it, please contact [email protected]. You may pick up your ticket the day of the BBQ, July 16 before 5:00 PM at the SIAM Registration Desk, Wilson Hall, University of Toronto.

Please check here if you are a MAA attendee who wants to register for the SIAM BBQ/Canadian Style on Thursday, July 16 for $20.00.

Contact Information

Name:
Organization:
Department:
Business Address:
City: State: Zip:
Country:
Telephone: E-mail:
Fax:
Home Address:
City: State: Zip:
Country:

Please send all SIAM correspondence to the following address:
Home Address Business Address

Name Badge Information:

NAME BADGE - I prefer my name and affiliation to read as follows:
Name (20 characters): Affiliation (20 characters):

Payment Information:

I wish to pay by:

Credit Card Number: Expiration Date:

Please submit this information to the SIAM Conference Department.



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MMD Created: 3/9/98 Updated: 4/28/98