Please send your registration form and payment to:
|Aileen R. Broccardo||Information and Computer Science||University of California, Irvine||Phone: +1 949-824-1357||ICS2 Room 110||Fax: +1 949-824-1715||Irvine, CA 92697-3425||Email: email@example.com|
Registration: Early registration must be received by Wednesday, August 11, 1999.
There will be on-site registration beginning at 7:30 a.m. on August 19, 1999, space permitting.
Upon registration, a confirmation email will be sent to you. A receipt will be provided upon check-in at the workshop.
Hotel recommendations, maps, and directions are available.
Written cancellations received FIVE working days prior to the workshop date are subject to a $50 cancellation fee. Registrants who fail to cancel in writing at least FIVE working days prior to the workshop are liable for the entire fee.
(by Wed., August 11)
Late or On-site
$175.00    $250.00      $50.00 - student    $100.00 - student
(payable to UC Regents)
Credit Card |
(Visa or Mastercard
(at workshop site only)
Credit Card Information:
_____________________________________ Name as it appears on the card _____________________________________ Credit card number and expiration date _____________________________________ Signature
Type or PRINT clearly:
Name:___________________________________________________________________ First Middle Last Affiliation:____________________________________________________________ Title:__________________________________________________________________ Address:________________________________________________________________ City: _______________________ State: _______________ Zip: ______________ Phone: _______________________________ Fax: ____________________________ Email: _________________________________________________________________ Dietary/access requirements: ___________________________________________ ________________________________________________________________________