is 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 September 29, 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 email@example.com
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 pre-registration
rates, an $80.00 savings, both the Registration Form and payment must
be received at the SIAM office by Monday, September 15, 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
Conference Registration Fee Includes:
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
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:
firstname.lastname@example.org; or mail: Society for Industrial &
Applied Mathematics, 3600 University City Science Center, Philadelphia,
(20 Characters): *
wish to pay by: *