SIAM 45th Anniversary and Annual Meeting

Preregistration Form


Registration Fees

Preregistration Deadline: June 30, 1997

SIAM MemberNon-Member Student
Short Course on Level Set Methods Sunday, July 13
Preregistration (Prior to 6/30/97) $150$180 $75
Registration (After 6/30/97) $180$210$75
Short Course on Linear Algebra Algorithms, July 13
Preregistration (Prior to 6/30/97) $150$180 $75
Registration (After 6/30/97) $180$210$75
Meeting July 14-18
Preregistration (Prior to 6/30/97) $165$200 $36
Registration (After 6/30/97) $205$250$36

Option and Rate Selection

I fall into this category: SIAM Member Non-Member Student

I want to register for one of the short courses. Both short courses will take place on the same day/same time so you cannot register for both. I want to register for the following short course:
Short Course on Level Set Methods
Short Course on Linear Algebra Algorithms

Based on the registration/short course fees chart and the options I chose, my short course fee is dollars and my registration fee is dollars.

I want lunch at $14.00 a person per day for
Monday 7/14 Tuesday 7/15 Wednesday 7/16 Friday 7/18

My total lunch fee should be dollars.

MY TOTAL FEE INCLUDING REGISTRATION, SHORT COURSE, AND LUNCH IS DOLLARS.


Will you attend the Welcoming Reception on Sunday, July 13? Yes No
Will you attend the Community Lecture on Tuesday, July 15? Yes No
Will you attend the Members Only Networking Box Lunch on Thursday, July 17? Yes No

Name, Address, and Phone Information

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

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

Please update my SIAM records to reflect the above:
Yes No

Are you a disabled participant that requires appropriate accommodations?
Yes No

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 SIAM.


To take advantage of preregistration rates, both Preregistration Form and payment must be received at the SIAM office by June 30, 1997.

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MMD, 4/22/97