SIAM-SEAS 2002 Annual Meeting and Student Conference

To register, please print, complete, and fax this form to the Division of Continuing Education and Summer School at 828-227-7115, or mail to Mr. Bobby Hensley, Director of Conferences and Institutes, Continuing Education, 138 University Outreach Center, Cullowhee, North Carolina 28723. Please make checks payable to Western Carolina University.

For more information on registration, e-mail: hensley@email.wcu.edu or phone 800-928-4968 or 828-227-7397.

Name __________________________________________________________
Address, line 1___________________________________________________
(City)____________________________ (State)_____(Zip code)____________
Telephone (work) _________________________________________________
Telephone (home) ________________________________________________
E-Mail Address __________________________________________________
Institution, Agency or Company Affiliation
______________________________________________________________

Registration Fees

If received by registration deadline, March 20:
____Student: $30
____Faculty or Professional: $45

If received after March 20, and in no event later than April 12:
____Student: $40
____Faculty or Professional: $55

____ Extra Friday evening social hour and dinner ticket(s): $16 each


____ Total Enclosed

If paying by credit card, please fill out the following information:

Circle one: VISA / Mastercard

Card Number ___________________________________________________

Expiration Date _______________________

Signature ______________________________________________________